

LIBRARY OF CONGRESS. 


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UNITED STATES OF AMERICA. 










































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PRACTICAL 


POINTS IN NURSING 

FOR 

Nurses in Private Practice 


WITH AN 


APPENDIX 


CONTAINING RULES FOR FEEDING THE SICK; RECIPES FOR 
INVALID FOODS AND BEVERAGES; WEIGHTS AND MEAS¬ 
URES; DOSE LIST; AND A FULL GLOSSARY OF MEDI¬ 
CAL TERMS AND NURSING TREATMENT 


BY 

EMILY A. M. STONEY 

w 

Graduate of the Training School for Nurses, Lawrence, Massachusetts; 
Late Superintendent of Training School for Nurses, Carney 
Hospital, South Boston, Massachusetts 

SECOND EDITION ,, THOROUGHLY REVISED. 


ILLUSTRATED WITH 73 ENGRAVINGS IN THE TEXT 
AND 8 COLORED AND HALF-TONE PLATES 


PHILADELPHIA 
W. B. SAUNDERS 
925 Walnut Street 
1897. 




SCP101M7 








» 



Copyright, 1897, by 

W. B. SAUNDERS. 


ELECTROTYPED BY 
WESTCOTT 81 THOMSON, PHILADA. 


PRESS OF 

W. B. SAUNDERS, PHILADA 






PREFACE TO THE SECOND EDITION. 


The call for a second edition of “ Practical Points 
in Nursing ” within less than a year since the appear¬ 
ance of the first edition is very gratifying. The entire 
book has been carefully revised, special attention having 
been given to the sections devoted to Obstetrics and 
Care of the New-born. 

The instructions as to how best to meet the various 
emergencies of medical and surgical cases are, it must 
be understood, to be used only in extreme cases, when 
at a distance from medical aid and the nurse has to act 
on her own responsibility. There could be no possible 
excuse for a nurse so acting with medical aid near at 
hand. 

EMILY A. M. STONEY. 


9 




PREFACE. 


In preparing the subject-matter of this volume, whose 
title-page clearly indicates its design, the author has 
attempted to explain, in popular language and in the 
shortest possible form, the entire range of private nurs¬ 
ing as distinguished from hospital nursing, and to instruct 
the nurse how best to meet the various emergencies of 
medical and surgical cases when distant from medical or 
surgical aid, or when thrown on her own resources, stu¬ 
diously refraining, however, from advising the nurse to 
act upon her own responsibility or to assume personal 
treatment of the patient except under circumstances of 
great urgency. There is simply placed before the nurse 
what the different diseases are, their characters and chief 
points of distinction and the attention required, their 
possible complications, and the treatment likely to be 
adopted in a given case by the family physician, so that 
suitable preparations may be made by the nurse. 

An especially valuable feature of the work will be 
found in the directions to the nurse how to improvise 
everything ordinarily needed in the illness of her patient. 
In the sick-room the embarrassment of the nurse, through 
want of proper appliances due to unexpected conditions 
or to her environments, is frequently extreme; the diffi¬ 
culty may frequently be overcome by the simplest means 
when one possesses a knowledge of how to apply them. 

There has also been attempted a logical division of 
the text, which includes the following sections : 


11 



12 


PREFACE. 


I. The Nurse; her responsibilities,qualifications,equip¬ 
ment, etc. 

II. The Sick-room ; its selection, preparation, and man¬ 
agement. 

III. The Patient; duties of the nurse in medical, surgi¬ 

cal, obstetric, and gynecologic cases. 

IV. Nursing in Accidents and Emergencies. 

V. Nursing in Special Medical Cases. 

VI. Nursing of the New-born and Sick Children. 

VII. Physiology and Descriptive Anatomy. 

The latter section, while sketched briefly, will be ample 
for the purposes of the nurse. The Appendix contains 
much information in compact form that will be of value, 
and the full Index presents a ready medium for quickly 
consulting any desired topic. 

The numerous illustrations added will be serviceable 
aids in making clear the application of certain lines of 
treatment falling specifically to the work of the nurse. 

Finally, this discussion, being based on a series of 
lectures delivered before the Carney Training-school for 
Nurses, will serve as a text-book for student nurses and 
a useful teaching-book for those occupying positions as 
teachers in training-schools ; and it may prove interesting 
to the “ home ” nurse who wishes to comprehend some¬ 
thing of the purposes of the different methods adopted 
in nursing-treatment. 

The Author’s sincere thanks are due to Dr. John R. 
Slattery for his technical revision of the work and for 
other kind assistance, and to all who have helped by 
friendly suggestions. 


EMILY A. M. STONEY. 


CONTENTS 


PAGE 

I. THE NURSE. 17 

Responsibilities of the Nurse, 17—Qualifications of the Nurse, 

19—Duties of the Nurse, 20—Hospital Etiquette; the Nurse’s 
Duties to her Superiors, 23—Etiquette when out Private 
Nursing, 24—Dress and Personal Habits of the Nurse, 25— 
Equipment of the Nurse’s Bag, 25—Keeping the Records, 25. 

II. THE SICK-ROOM. 29 

Selection and Preparation of the Sick-room, 29—Preparation of 
the Bed, 29—Changing the Bed-clothing, 30—Bed-making for 
Different Cases, 32—Appliances for the Relief of Bed-patients, 

34—Care of the Sick-room, 36—Hygiene of the Sick-room, 36. 


III. THE PATIENT. 39 

1. Nursing in Medical Cases . 39 


1. General Obsewations in Medical Cases : The Pulse, 39—Body- 
temperature, 41—Respiration, 44—Observation of Symptoms, 
45- 

2. Bodily Care of the Patient : Changing the Clothing, 52— 
Toilet of the Patient, 53—Baths, 55—Feeding of the Patient, 
56—Moving of the Patient, 57. 

3. Relief of Functional Disturbances: Enemata, 59—Rectal 
Feeding, 64—Douches, 65—Catheterization, 68—Washing out 
the Bladder, 69—Washing out the Stomach, 70. 

4. Administration of Medicines : Rapidity of Absorption of 

Medicines, 70—Action of Medicines, 71—Precautions to be 
Observed in Handling and Administering Medicines, 72. (1) 

Medicines by the Mouth, 74. (2) Medicines Administered per 
Rectum, 76. (3) Subcutaneous Administration of Medicine ; 

Hypodermatic Injection, 76. (4) Inunctions, 78. (5) Inhala¬ 

tions, 80. 


13 







14 


CONTENTS. 


PAGE 


5. General and Local External Applications : Baths, 81—Symp¬ 
toms of Inflammation, 91—Treatment of Inflammation, 91— 
Bleeding, 92—Fomentations, 94—Poultices, 95—Dry Heat, 

101—Application of Cold, 101—Counter-irritants, 104— 
Blisters, 106—Massage, 108—Liniments, 110—Lotions, no— 
Gargles, Sprays, etc., no—Eye-drops, 112. 

11. Nursing in Obstetric Cases.115 

Pregnancy, 115—Signs and Symptoms, 115—Duration of Preg¬ 
nancy, 116—Conception and Date of Confinement, 116—The 
Fetus, 117—Fetal Movements, 118—Disorders of Pregnancy, 

119—Termination of Pregnancy, and Nurse’s Preparations for 
the Confinement, 120—Labor, 122—Stages of Normal Labor, 

123.—Duration of Labor, 126—Conduct of Normal Labor, 126 
—Management of the Puerperium, 129—Pathology of the Puer- 
perium, 133—Extra-uterine Pregnancy, 136—Cesarean Section, 

136. 

in. Nursing in Gynecologic Cases.137 

Preparation for Gynecologic Examination, 137—Positions for 
Examination, 137—Preparation for Operation, 140—After-care 
of Patient, 143. 

iv. Duties of the Nurse in General Surgical Cases . . . 144 
Preparation of the Operating-room, 144—Preparations for the 
Operation, 146—Preparation of the Patient, 149—Duties of 
the Nurse in Emergency Cases, 151—Nurse’s Duties in 
Operating-room, 156—Arranging the Patient for Operation, 

158— After-care of the Patient, 159—Sequelae of Operation, 

159— After-treatment of Patient, 163—Surgical Disinfection 
and Materials, 167. 

IV. ACCIDENTS AND EMERGENCIES.172 

1. Surgical Accidents: Fractures, 172—Dislocations, 176— 
Sprains, 176—Surgical Dressings, 176—Bandages, 178— 
Splints, 186—Extension, 187—Wounds, 188—Gangrene, 191 
—Abscess, 192—Boil, 192—Carbuncle, 192—Ulcer, 192— 
Fistula, 192—Sinus, 192. 

2. Common Emergencies : Hemorrhages, 193—Burns and 
Scalds, 197—Sunstroke, 200—Heat-exhaustion, 200—Light¬ 
ning-stroke, 201—Fainting, 201—Drowning, 201—Accidents 
from Fire, 203—Retention of Urine, 203—Head-accidents, 

203—Cuts and Bruises, 204—Foreign Bodies, 204—Insect 





CONTENTS. 


15 


PAGE 

Bites and Stings, 205—Dysmenorrhea, 205—Vomiting, 205— 
Flatulence, 206—Toothache, 206—Insomnia, 206—Sunburn, 

206—Frost-bite, 207—Chilblains, 207. 

3. Accidental Poisoning : Poison Defined, 208—Classification 
and Action of Poisons, 208—What to do in Case of Poison¬ 
ing, 208—Irritant Poisons, 209—Narcotic Poisons, 211—Bites 
of Rabid Animals, 212. 

V. NURSING IN SPECIAL MEDICAL CASES.213 

1. Infectious and Contagious Diseases : Infectious Diseases, 213 
—Contagious Diseases, 214—Typhoid Fever, 215—Scarlet 
Fever, 222—Typhus Fever, 225—Small-pox, 226—Measles, 

228—Diphtheria, 229—Fumigation of Sick-room after Con¬ 
tagious Diseases, 234—Phthisis, 236—Simple Croup, 237— 
Membranous Croup, 238—Whooping Cough, 238. 

2. Functional and Idiopathic Diseases : Influenza, 239—Croupous 
Pneumonia, 241—Bronchitis, 242—Asthma, 243—Pleurisy, 

243—Empyema, 243—Angina Pectoris, 244—Gastritis, 244— 
Peritonitis, 245—Appendicitis, 246—Dysentery, 248—Cholera 
Morbus, 249—Acute Diarrhea, 250—Uremia, 250—Cerebro¬ 
spinal Meningitis, 251—Cerebral Apoplexy, 251—Paralysis, 

254—Epilepsy, 254—Hysteria, 256—Neurasthenia, 257— 
Dropsy, 257—Diabetes, 258—Rheumatism, 258—Diseases of 
the Skin : Eczema, 259—Scabies, 259—Ringworm, 260— 
Herpes Zoster, 260—Caring for the Dead, 261. 

VI. NURSING OF SICK CHILDREN.262 

Care of the New-born, 262—Care of Premature Infants, 269— 
Diseases of Infancy, 270—Diseases of Childhood, 278—Sur¬ 
gical Diseases of Children, 280—Nurse’s Management of 
Children, 281. 

PHYSIOLOGY AND DESCRIPTIVE ANATOMY.285 

1. Physiology : Blood-circulation, 285—Respiration, 289—Diges¬ 

tion, 290—Secretions, 292—Excretions, 293—Urinary Organs, 

293 - 

2. Descriptive Anatomy : The Skin, 296—The Bones of the Body, 

296—The Muscles of the Body, 299—Heart, Blood-vessels, 
and Lymphatics, 300—Brain, Cord, Nerves, and Organs of the 
Senses, 301—Respiratory, Digestive, and Urinary Organs, 305 
—Internal Female Organs of Generation, 309. 





1 6 CONTENTS. 


PAGE 

APPENDIX.311 

I. General Rules for Feeding the Sick and How to make 

Certain Articles of Food . .•.311 

1. Serving the Food.311 

2. Recipes for Invalid Foods and Beverages.317 


Simple Farinaceous Foods, 317 —Beef-teas and Extracts, 
319 —Broths, 321 —Oysters, 322 —Puddings, 323 —Soups, 
324 —Miscellaneous Dishes, 325 —Prepared Milk, 327— 
Toasts, 328 —Desserts, 329 —Beverages, 333 —Mineral 


Waters, 337. 

II. Weights and Measures.340 

III. Table for Computing Date of Labor.343 

IV. Abbreviations.344 

V. Dose List.. . . •.346 

VI. Glossary .369 

Index.433 












Practical Points in Nursing 

FOR NURSES IN 

PRIVATE PRACTICE. 


I. THE NURSE. 

Responsibilities of the Nurse.—In these pages the 
writer will endeavor to tell the nurse what she can do 
when private nursing, especially among the poor, who 
have not the proper things to do with; what she can use 
in place of the things used in the hospital; also what 
she can do in an emergency when at a distance from 
medical aid, and when she must use her own knowledge 
and judgment. It is for this reason that the writer de¬ 
sires the nurse fully to understand, and to have an intel¬ 
ligent idea about, the different cases which are most 
likely to come under her care. These instructions are 
not intended for hospital use; indeed, there would be no 
possible excuse for the nurse to act on her own respon¬ 
sibility in the hospital, as there is always a doctor within 
calling distance, while in private practice she is left alone 
with the patient, and is expected by the doctor or the 
surgeon to know what to observe and to do in emer¬ 
gencies until he arrives. 

The profession of nursing is one in which there is 
no limit to the good that can be done; it is*also one in 
2 17 



1 8 PRACTICAL POINTS IN NURSING. 

which every woman embracing it must “ walk worthy of 
the vocation wherewith she is called.” “ A nurse should 
have such tact, as well as skill, that she will do what is 
best for the patients, even against their will, knowing 
how to manage the weakest and most irritable, and 
doing all that is necessary for them without their know¬ 
ing it.” “ She must be scrupulously clean and neat in 
her own person, especially with regard to the arrange¬ 
ment of her hair, which should be smooth and well kept. 
The office of nurse is too high and too holy for any woman 
called to it to wish to devote much time to the adornment 
of her person. Her one object, as regards herself, should 
be to be clean, simple, neat, modest, sweet-tempered, and 
to know how to mind her own business ”—to keep her 
health unimpaired by securing sufficient rest, sleep, food, 
and exercise, without which the best will break down 
and suffer in health. 

A nurse should improve her mind by reading the best 
books at her command, by going out*and visiting friends, 
and by attending the theatre twice a month : this will keep 
her in touch with outside affairs, and she will be able to 
converse intelligently with her patients. Her manner 
toward her patients and toward all with whom she comes 
in contact should be kind, pleasant, courteous, and cheer¬ 
ful—repressing all attempts at familiarity. It should be 
remembered that while we cannot dictate the manner of 
other people toward us, yet we can to a certain extent 
have it what we would like it to be; and we can always 
control our bearing toward them. The nurse should 
cultivate a contented mind and a cheerful face, avoid 
affectation and all temptation to air her knowledge—a 
mistake that many nurses are prone to make—and learn 
to control her emotions. The patients should be made 


THE NURSE. 


19 

to feel that they are her first thought, and they will learn 
to have faith and trust in her. 

Unlike physicians, nurses are not called upon to attend 
charity calls. Very few nurses during their first year of 
private practice are worth the large fees they ask and 
receive. This mercenary spirit is steadily increasing, 
instead of decreasing. It would be well for all nurses to 
remember the words of the late Dr. Agnew: “ It is a 
great and a good thing to feel that you are not always 
working for mere money.” This feeling a nurse will not 
have if she enters into the work for the love of the good 
that can be done in lessening the weariness of pain and 
misery with which she comes in contact. 

No nurse should take up the work unless she feels 
that to serve the poor is her vocation. She must try 
how much she can do for each patient, remembering 
that, so far as the nature of the work admits of it, every 
poor person should be as well and as tenderly nursed as 
if he were the highest in the land. The very essence of 
nursing in the homes of the poor is management, tact, 
and thinking for the patient. Applications of poultices 
are not the only duties of a nurse, although they are in 
themselves of vast importance. 

The writer wishes particularly to impress upon the 
nurse the responsibilities of night duty. It is in the 
night-time that a very large majority of patients require 
the most careful watching and nursing. It requires a 
very competent nurse to do night duty—one who is 
gentle, kind, charitable, and patient; a large stock of 
patience is always necessary because of the large de¬ 
mands that are made upon it during the night. 

Qualifications of the Nurse.—The questions asked 
by physicians and surgeons before employing a nurse 


20 


PRACTICAL POINTS IN NURSING. 


are: Is she neat and clean, and does she understand all 
the recent antiseptic methods ? Is she competent to meet 
an emergency ? Does she know what to look out foi in 
the cases under her care, and when to send for the physi¬ 
cian ? Is she modest in assuming responsibility ? faith¬ 
ful to the physician’s orders ? patient, and fitted for the 
cares of a severe and critical illness ? All these ques¬ 
tions are asked, together with others, and it is a nurse 
possessing just these qualifications that each one should 
wish to be. 

Duties of the Nurse.—On first going to the house 
the duty of the nurse is to find out where everything 
that will be needed is kept, then to wait on herself quietly 
and without intruding. 

The time of the nurse belongs to the family em¬ 
ploying her, but she has full control of the patient and 
the sick-room. There is no place where the presence 
of mind and powers of observation of a nurse show 
so plainly as in the operating-room; so do the gentle¬ 
ness, modesty, refinement, and cheerfulness of a nurse 
shine clearly in the sick-room. 

A nurse should be as little trouble to the family as 
possible, and improvise all she can, remembering that 
they are under very great expense. The same caution 
should be observed in dealing with the servants : she 
should be kind to them, and add as little as possible 
to their work in the kitchen or the laundry. She should 
wash and put away all glasses and dishes used for the 
patient, as is done in the hospital; they must not be left 
in the kitchen for some member of the family or the ser¬ 
vants to wash; the nurse must do it herself. 

The patient should closely be observed, and all that 
can be done to make her comfortable should be antici- 


THE NURSE. 


21 


pated, not waiting to be asked for anything. The nurse 
should wear noiseless shoes, and move about the room 
quietly; she should look where she is going, and not 
knock against the bed or the furniture, avoiding every¬ 
thing which may annoy the patient. 

The nurse should begin early in the evening to pre¬ 
pare for the night—to get everything that will be needed, 
and when moving around in the night should make no 
noise, so that the patient and the family will not be dis¬ 
turbed. 

Sleep must be taken when it is most convenient for 
some member of the family to relieve her; the same 
with the meals, which should be taken alone, unless the 
family really wish her presence at their table. At such 
times, when she is away from the patient, written orders 
for the substitute must be left, and she should make 
sure that the one who takes charge understands thor¬ 
oughly how everything is to be done. 

The answer to the question, Should a nurse refuse to 
take her meals in the kitchen ? depends on the circum¬ 
stances of the family. It does not at all lessen the dig¬ 
nity of the nurse to eat in the kitchen, a gentlewoman 
being always treated as one wherever she is. It is not 
degrading to assist in the kitchen when emergencies 
arise; it shows the true spirit of a nurse, and the kind¬ 
ness is not lost. 

A nurse must not talk of her hospital days; she will 
find a number of patients very curious to hear of the 
different cases and operations that she has seen, but 
they must not be talked of; it has a depressing effect 
on the patient. A nurse must be cheerful and talk of 
cheerful things. Nor must she tell of her experiences 
in other families: all that she hears or sees in the family 


22 


PRACTICAL POINTS IN NURSING. 


for whom she is working must be kept secret and re¬ 
vealed to no one; she has no right to speak of one 
patient to another in private or hospital practice, or to 
criticise or discuss her patient’s peculiarities outside her 
report to the physician. 

The directions of the doctor must faithfully be carried 
out, and in the absence of directions the nurse should 
think what he would like to have done. When she makes 
a mistake, it should be confessed at the first opportunity ; 
the physician will always be found very kind; but if 
mistakes are left for him to find out, he will naturally 
lose confidence in his nurse. 

If any trouble should arise regarding meals, sleep, 
getting fresh air, or anything else, the nurse must not 
worry the patient about it, but speak to the physician, 
who will always be found a warm friend. 

A nurse will often work for doctors who treat their 
cases entirely different from the way she has been used 
to seeing them treated. The doctor makes the diagno¬ 
sis and gives his orders as to the treatment of the case, 
and, no matter what the nurse may think, it must not 
interfere with her accurate and faithful execution of those 
orders. She should never be guilty of making sugges¬ 
tions to the doctor: she is there to carry out his orders, 
to observe every little thing about the patient, and to re¬ 
port to him in a clear, simple way; her judgment must 
never be allowed to prevent her from doing her duty to 
the physician in charge. 

Some families may question the nurse very closely 
about the attending physician. She must be very 
careful how she speaks of him, and inspire all pos¬ 
sible confidence in him, whether she has or has not 
worked for him before. The family may likewise ques- 


THE NURSE . 


23 


tion the doctor about the nurse; the battle is half won 
when the family has confidence in both physician and 
nurse. 

Hospital Etiquette; the Nurse’s Duties to her Su¬ 
periors.—The difference between hospital nursing and 
private nursing is very great. The regularity of hospital 
life and the strict discipline which prevails are of great 
benefit to a nurse in assisting her to become punctual, 
trustworthy, patient, obedient, and courteous. Every¬ 
thing needed in the care of the sick is at hand in the 
hospital, and a sister-nurse and a doctor within calling 
distance. She has a number of patients under her care, 
whereas in private nursing she has to do with a single 
patient, and her success depends mainly upon making 
the relation one of satisfaction and esteem, and upon her 
ability to meet the sudden emergencies which may arise, 
having no longer the sister or doctor to call upon. There 
are also anxious friends and relatives to meet, and who 
in their own opinion know how everything ought to be 
done. 

The presence of a senior or a junior member of the 
hospital staff, the superintendent of the hospital, the 
superintendent of nurses, or strangers visiting the hos¬ 
pital is a severe test of the professional manners of a 
nurse. A nurse must always receive any hospital officials 
standing, and remain standing like a sentinel on duty 
until they have left the ward or room. It is a courtesy 
due to the position which they hold. During the visit 
of a physician the nurses must be ready to accompany 
him, and answer any questions he may ask. If the 
head-nurse is in the ward, she will accompany the doc¬ 
tor on his rounds and answer all questions. A nurse 
must never answer a question or give the doctor any 


24 


PRACTICAL POINTS IN NURSING. 


information about a patient or patients when the head- 
nurse is present, unless the question is put directly to 
her. The head-nurse is responsible for everything that 
occurs on the floor of which she has charge, and it is 
the duty of the nurses to keep her fully informed of 
everything relating to the patients. Perfect quiet must 
prevail while the doctor is using the stethoscope. 

Etiquette when out Private Nursing.—Regarding 
the etiquette when private nursing, there are no definite 
rules to be observed. It is a mark of respect for the 
nurse to rise when the physician enters the room, and 
to remain standing unless asked to be seated; she 
should hand him her report, answer all questions, then 
quietly leave the room. This is a good plan in both 
private practice and for hospital private patients, for in 
many cases the physician is the family friend, and there 
may be many things about which the patient would 
like to speak with the doctor, and not care to have the 
nurse hear. If the nurse observes this course from the 
beginning, it will save her the probable embarrassment 
of being asked to leave the room. Then, again, she 
will have an opportunity of speaking to the doctor of 
anything relating to the case of which the patient 
should not know. 

She should also leave the room when a visitor comes, 
so that patient and friend can enjoy their talk alone; if 
the visit is limited, the visitor should be told when the 
time has expired. 

A nurse should not whisper in the sick-room; it 
makes the patient think she is being talked about: it 
should be remembered that the hearing of a patient who 
is apparently insensible, unable to move or to speak, is 


THE NURSE. 


25 


often very acute, hearing the lowest whisper; so the 
case should not be discussed nor any but the kindest 
things be said before a patient. 

Dress and Personal Habits.—The dress of a nurse 
should be of cotton goods. She should always wear her 
cap; it is her “ badge of authority.” Her appearance must 
at all times be as though she had just been lifted out of 
a bandbox. At night she should wear a flannel wrapper 
and soft shoes and look as neat as in the daytime. She 
should shun curl-papers; under no consideration must 
she be seen with them or even be seen using curling- 
irons, or she will lose the respect of the patient, the 
family, and the physician. 

Equipment of the Nurse’s Bag.—Some of the things 
which every nurse should carry in her bag are—a clin¬ 
ical thermometer ; a pair of surgical scissors and forceps ; 
a bottle of brandy; a hypodermic syringe; a fountain 
syringe; two glass catheters; a flexible catheter; small 
bottles of corrosive tablets; carbolic acid, 1:20; per- 
manganate-of-potash crystals; oxalic-acid crystals and 
washing soda; rubber tubing; a razor; large and small 
safety-pins; needles and white thread ; one-ounce grad¬ 
uate minim-glass ; a medicine-dropper ; temperature and 
nourishment charts; gauze sponges of various sizes; a 
small ice-pick; matches. 

A fountain syringe will be found very handy in pri¬ 
vate practice. It can be used for a number of things—to 
wash out the stomach and bladder, for douches, as an 
irrigator, and the rubber-tubing attachment can be de¬ 
tached and be used as a tourniquet. 

Keeping the Records.—It is a good plan to write out 
the physician’s orders on paper, for instance : 


26 


PRACTICAL POINTS IN NURSING. 


A/r-n £ . f IO. 12 A. M. 

Milk, 6 ounces, at < s Q 

’ ’ \ 2, 4, 6, 8 p. m. 

Ordered medicine, i teaspoonful, at | * 1 ^ p M M 
Whisky, | ounce, at { A '£ M 

Flaxseed poultices to chest, at | ^^ p M M 


The hours must be checked off as they are filled. If 
the orders keep about the same, the paper will last two 
days by checking the opposite way on the second day. 
The day or night Report will run somewhat as follows : 


Day Report. 
Mrs.- 


Extra-uterine. 


Milk, 2 ounces, 8, 9, 10, 11, 12 A. M; 1, 2, 3, 4, 5, 6, 7 p. m. 
24 ounces. 


Total, 


Whisky, 2 drachms, 8 30 , 9 30 , io 30 , 11 30 , 12 30 A. M. ; I 30 , 2 30 , 3 30 , 4 30 , 5 30 , 
6 30 , 7 30 p. m. Total, 3 ounces. 

Strychnia, gr. subcutaneously, 9, 11 A. m. ; I, 3, 5, 7 p. m. Total, 
& ths - 


Milk, 4 ounces, ") 

Whisky, 1 ounce, I ^ rectum - 10 A - M '' 2 > 6 p - M - Retained. 

Effervescent citrate of magnesia, bottle i. Given in divided doses dur¬ 
ing the day. 


Low enema of— 
Turpentine, \ ounce, 
Epsom salts, 3 ounces, 
Glycerin, 4 ounces, 
Warm water, 12 ounces, 


at 9 A. m. Was not retained, 
soon as injected. 


Returned 


High enema of— 

Turpentine, I ounce, 
Magnesia sulphate, 1 ounce, 
Glycerin, 4 ounces, 

Warm water, 8 ounces, 


at 10, 11 A. m., 1 p. m. Was not re¬ 
tained. Returned soon as injected. 


Rectal tube inserted, very little gas expelled. Abdomen very much 
distended. 





THE NURSE. 


2 ; 


Urinated at 10 A. m., 3 ounces, ^ 

“ “ 3 p. m., 6 ounces, l Total, 13 ounces. 

“ “ 6 p. m., 4 ounces, J 

Bowels did not move. 

Though patient did not sleep, yet she had a comfortable day. 


Night Report. 


Mrs. 


Magnesia sulphate, 1 drachm, 

Hot coffee, 1 drachm, 

Strychnia, gr. subcutaneously, 9, 11 p. m. ; 1, 3, 5, 7 A. M. Total, 

2 6 5 ths - 

Whisky, A ounce, 8, 10, 12 p. m. ; 4, 6 a. m. Total, 2 \ ounces. 

Oxalate cerium, grs. 5, at 9, 10. Total, 10 grains. 

Nourishment— \ 

Milk, 10 ounces, > Total, 15 ounces through the night. 

. Beef-tea, 5 ounces, ) 


J 8 P. M. 


Temperature and pulse taken every two hours and recorded on chart. 


Urinated at 9 p. M., 2 ounces, 
“ “11 p. m., 3 ounces, 

“ “ 2 A. M., 5 ounces, 

Bowels moved at 9, 11.30 P. M. 
“ “ “ 2 A. M. 


Total, 7 ounces. 

Very good movements, character 
loose; movements, though 
small, were very good. 


After bowels moved at 9 o’clock distention gradually disappeared; very 
little distention this morning. Passed considerable gas. 

Slept continuously 1^ hours, ^ 

“ “ iA “ l Total, 5 hours. 

“ at intervals 2 “ j 

Had a comfortable night. 


Another favorite way is to rule a sheet of paper, leav¬ 
ing spaces for the hour, temperature, pulse, nourish¬ 
ment, stimulant, medicine, sleep, and remarks. For in¬ 
stance : 



28 


PRACTICAL POINTS IN NURSING. 


Date. 


Hour. 

Temp. 

Pulse. 

Nourishment. 

Stimulants. 

Medicine. 

Urine. 

Bowels. 

Sleep. 

Remarks. 

7 A. M. 

8 “ 

9 “ 

10 “ 

11 « 

12 “ 

1 P. M. 

2 “ 

3 “ 

4 “ 

5 “ 

6 “ 

7 “ 

8 “ 

9 “ 

10 “ 

11 “ 

12 midnight. 

1 A. M. 

2 “ 

3 “ 

4 “ 

5 “ 

6 “ 

7 “ 










Total. 











These twenty-four-hour charts, or records, are very 
useful for operative cases where the treatment is con¬ 
tinually changing. The report should be made out and 
ready for the physician, and everything that has hap¬ 
pened since his last visit be written clearly and defi¬ 
nitely; also what the nurse has done. This detailed re¬ 
port will save questioning in the presence of the patient. 











































THE SICK-ROOM. 


29 


II. THE SICK-ROOM. 

Selection and Preparation of the Sick-room.—The 
sick-room should be on the sunny side of the house 
and capable of thorough ventilation. If there is a 
stationary basin in the room, it should be covered with 
paper or a board, or be kept filled with water, which 
must be changed often; this will prevent impure air 
coming up through the waste-pipe should the pipe not 
be properly trapped. The room should be as near the 
top of the house as possible, for the reason that the 
higher we go the purer is the air, and also that if a 
room on the lower floor is used the germs of the disease 
will be carried upward. If the light is too bright, the 
bed should be so made that the patient will lie with the 
back to the window, or a screen may be put before the 
window. If the case is disease of the brain or the eye, 
the room must be darkened; the curtains so arranged 
that there will be no flapping when the window is open, 
nor flashes of light. 

Preparation of the Bed.—Probably the first thing 
that will need the attention of the nurse will be the bed. 
In very few families will she find the mattress protected, 
which should be done both for cleanliness and expense. 
Many think that in the absence of a rubber sheet or an 
oilcloth an old blanket or a comforter will do to protect 
the mattress, but such substitutes must not be used if it 
can possibly be avoided, as it is impossible to know 
where they have been or how dirty they are; they may 
be filled with germs. Newspapers can always be pro¬ 
cured, which will absorb the discharges, and which can 
be burned when removed. They are to be placed be- 


30 


PRACTICAL POINTS IN NURSING. 


tween the under sheet and draw-sheet, which, if put on 
here, will keep the under sheet clean much longer. 

In making the bed the under sheet should be well 
tucked in at the top and sides, even if it is a little short 
at the bottom, for it is easier to pull an under sheet 
down from the bottom than to pull it up from the top. 
Next comes the rubber sheet, oilcloth, or newspapers. 
The four corners of the rubber sheet must be pinned to 
prevent wrinkling. The smooth end of the draw-sheet 
must come under the patient’s back. The upper cloth¬ 
ing must be well tucked in at the foot, still not too 
tightly, and the nurse should guard against a weight 
of clothing lying on the patient’s chest; if the sheets 
or blankets are very long, the surplus must be brought 
down to the foot of the bed. 

Changing the Bed-clothing.—Before beginning to 
change the bed- or body-linen the nurse should get 
everything ready and thoroughly aired and warmed. 
The patient is moved to the other side of the bed, and 
the upper and under sheets are loosened; then the upper 



Fig. i.—C hanging the bed-sheet without removing patient from the bed (a, sheet 
partly rolled ; b, sheet partly folded). 


clothing and under sheets are pushed well over against 
the patient’s back, and the clean sheet, rubber, and draw- 
sheet inserted, the under sheet being tucked in at the top 
and sides, and rolled up close to the soiled sheet (Fig. i). 



























THE SICK-ROOM. 


31 


The upper clothing is then spread out, and the patient 
moved back to the clean side, after which the soiled sheets 
can be removed, and the clean sheets be well stretched 
and tucked in at the top and sides. To change the 
upper sheet, the spread and one blanket are removed ; 
over the soiled sheet put the clean sheet and blanket; 
then, with one hand holding the clean sheet and blanket, 
the soiled sheet and blanket are drawn down toward the 
foot of the bed and removed with the other hand. In 
changing the bed in this way we guard against exposing 
and chilling the patient. 

When the patient cannot turn on the side, the bed 
should be changed from the top, the soiled sheet being 
first loosened at the top and sides and pushed well 
down under the pillow. Another person must assist at 
the other side of the bed in working down the two 
sheets ; the shoulders, back, and upper part of the thighs 
of the patient must be raised with one hand, while the 
sheets are worked down with the other hand. In case 
of a fractured limb, one person must support the limb 
above and below the fracture, taking care to raise the 
limb very gently. 

When arranging the pillows, the head of the patient 
should be lifted and supported by the nurse’s arm, her 
hand supporting the back; with the other hand the pil¬ 
low is turned, the lower pillow being brought under the 
shoulders to support the back, the upper one to support 
the head without bringing it too far forward or too far 
backward. The patient must be permitted to suit herself 
in arranging her pillows, as every patient has a favorite 
way. A pillow should never be shaken up on the bed; 
the upper pillow should be removed and shaken away 
from the bed, then the second pillow taken out, replacing 


32 PRACTICAL POINTS IN NURSING. 

it with the fresh one, so that the patient will always have 
one. 

Bed-making- for Different Cases.—We will now con¬ 
sider the making of beds for the different cases which 
come under the nurse’s care. In private practice the 
supply of bed-linen may be veiy limited, and for this 
reason it would be well first to put on the under sheet, 
then the protector, which may be of rubber, ordinary 
table oilcloth, or newspapers, then the draw-sheet; by so 
doing the under sheet will be kept clean much longer. 

Medical and Surgical Beds. —A medical and a surgical 
bed is made with an under sheet, a protector, a draw- 
sheet, and the usual upper clothing. If the bed is to be 
prepared for a patient with a broken limb, a wide board, 
table-leaf, or small strips of board (slats) or an ironing- 
board must be placed across the middle of the bed, 
under the mattress, to make the bed firm and prevent 

sa gg in g- 

Obstetric Bed. —An obstetric bed is made with an 
under sheet, a protector, and a draw-sheet, then over 
these a second protector and sheet; this is called a 
“ temporary ” bed, which, after all is over, is easily re¬ 
moved, and the patient lies on a clean bed; both beds 
during labor must be pinned securely to the mattress 
at each corner, the protectors also being pinned at their 
four corners. If the bed is a large double bed, then one 
side of it should be prepared, or the lower part of one 
side. After delivery the patient is lifted to the other 
side, or to the upper part of the bed, whichever has been 
prepared. Here the writer again warns the nurse not 
to use old comforters or blankets, unless positively sure 
that they are clean ; if there is any doubt about it, then 
give way to the doubt by not using them. 


THE SICK-ROOM. 


33 


Cross-bed. —A cross-bed is very often used for gyne¬ 
cologic examinations and minor operations : the pillows 
are arranged across the bed in the middle, which arrange¬ 
ment brings the hips of the patient to the edge of the 
bed; across the mattress under the sheet is slipped a 
table-leaf or board, which will, to a certain extent, take 
the place of the examining table; the patient lies upon a 
hard surface, thus preventing the body sinking into the 
bed. A sheet and a blanket are the upper coverings. 

Divided Bed. —Some surgeons like the upper bed-cloth¬ 
ing divided for abdominal cases. For this form of bed 
there are needed two sheets and two single blankets, 
which are doubled, placed over the patient, and meet in 
the centre, the sheets first, then the blankets. The upper 
clothing is thus divided into two distinct halves; the 
bed-spread being put on as usual. When the dressing 
is to be done, the spread is thrown back and the sheets 
and blankets parted, so that unnecessary exposure of 
the patient is guarded against. 

Water-bed and Air-bed. —Water- and air-beds are used 
in cases of long illness, and in cases where bed-sores are 
formed or where there is a tendency to them, and where 
there is much moisture. The water-bed is placed on the 
bed-springs, which should be covered with rubber sheet¬ 
ing, a comforter, or paper, to prevent rusting, and the 
bed filled with water (at a temperature of about ioo° F.) 
by means of a funnel and pitcher. To empty a water- 
bed, it is laid in a slanting position until all the water has 
run out; it is then rolled up and laid away. India rub¬ 
ber, if unused for any length of time, becomes hard and 
is apt to break, and for this reason the bed should be 
filled every six weeks or oftener, the water remaining in 
it three or four hours. The air-bed is filled with air by 




3 


34 PRACTICAL POINTS IN NURSING. 

means of a pair of bellows or an air-pump ; after filling, 
it is made up in the usual way. Care must be taken 
that these beds are not pricked with pins, or they will 
collapse. 

Appliances for the Relief of Bed-patients.—In very 
few families will a nurse find a bcd-cradle , a screen , a bed- 
test , pads, and rings. 

The cradle (Fig. 2) can be improvised by taking one or 

two chairs, placing them 
backs uppermost, and 
securing them by tying 
their two lower legs to 
the sides of the bed; 
to be sure, they look 
clumsy, but a chair is 
always to be had in the 

F,o. 2. Cradle for prelecting patient from pros- b Q f anything else, 

sure of bed-clothes. J 

Half barrel-hoops, with 
a string fastened to each end to be tied to the sides of 
the bed, make a good cradle; three halves are all that 
are needed. A cradle must always be placed under the 
blankets, the sheet covering the patient to prevent her 
taking cold. 

Bed-rest. —A straight-backed chair answers nicely for 
a bed-rest; one pillow should be carried well down in 
the small of the back, another (if there are only two) 
is placed above for the head and shoulders. 

Bed-screen. —A clothes-horse covered with a sheet, a 
blanket, or a shawl makes a very good screen; it can be 
made quite attractive by tying the corners of the covering 
with ribbon and pinning on it photographs or pictures 
cut from illustrated papers; they will help to amuse the 
patient, and should be renewed from time to time: if the 












THE SICK-ROOM. 


35 



case is contagious, of course the pictures should be 
burnt each time they are renewed. 

Pads and rings (Fig. 3) to relieve pressure are made 

of cotton - batting, blanket, 
compress, oakum, horse-hair, 
straw, or even of a sheet, 
formed into a circular pad 
(having a hole in the centre), 
covered with compress, and 
wound around with a band¬ 
age to keep it in place. 


Fig. 3.—Heel-pad or ring : a, 
end of bandage. 


Fig. 4.—Bed-cushion. 


A cushion (Fig. 4) for the foot of the bed to prevent 



the patient slipping down, or to be placed under the 
knees to relax the abdominal muscles, may be impro- 





























36 PRACTICAL POINTS IN NURSING. 

vised by putting a clean blanket or a comforter in a 
pillow-case. 

During convalescence the Nightingale wrap will be 
found useful. It is made of two yards of flannel of 
ordinary width. A straight slit 6 inches deep is cut in 
the middle of one side; the points are turned back to 
form the collar. The points farthest from the collar are 
turned back to form cuffs. Buttons and button-holes 
are added, as shown in the illustration (Fig. 5). The 
wrap can be ornamented if desired. 

Care of the Sick-room.—It should be remembered 
that the sick-room is the home of the patient during the 
time she is in it; hence great pains should be taken by the 
nurse to keep the room clean, the air pure and fresh, and 
herself bright, cheerful, quiet, and gentle, so that when the 
illness of the patient is a thing of the past, she will look 
back to the pleasant room, the systematic way in which 
everything was done, the kindness of the physician and 
nurse. Sweeping must be done slowly, the broom being 
kept near the floor, lest the dust be thrown around and 
back ; the sweepings must be gathered up and burned. 
A damp cloth should be used to dust with; if a feather- 
duster or a dry cloth be used, the dust is thrown around 
the room and settles again. If there is a fire in the room, 
the coal should be wrapped in paper or placed in paper 
bags before carrying it to the room; it can then be 
dropped on the fire without noise. 

Hygiene of the Sick-room. — Temperature .—The 
temperature of the room must be kept as even as pos¬ 
sible ; for lung troubles it should be kept about 70° F., 
but in fevers it should be lower, about 65° F. A point to 
be remembered is that the temperature decreases at night, 
and that between the hours of 12 and 4 a . m . the vital 


THE SICK-ROOM. 


37 


powers are at their lowest ebb; the sick patient must 
be carefully watched and hot drinks be given, and extra 
blankets and heaters be applied if necessary. The tem¬ 
perature must be regulated by opening or closing the 
registers, and applying extra clothing, not by closing 
the windows, thus shutting off the fresh air. Dry air, 
which is irritating, can be made moist by keeping a kettle 
of boiling water in the room, or by dropping very hot 
bricks into a pail of water, or, if there is a fire or register 
in the room, blankets or sheets wrung out of water may 
be hung up to dry. 

Air .—The air of the room must be kept pure, whole¬ 
some, and cool. To keep a room cool in hot weather is 
not always an easy matter, but good results have been 
obtained by keeping the windows and blinds closed dur¬ 
ing the day, thus shutting out the hot air and sun, and 
opening them in the evening when the air has become 
cooler, because, if the hot air be let into the room during 
the day, it remains, and the room is hot for the patient 
at night; whereas, if the windows and blinds be kept 
closed during the day and opened in the evening, when 
the air is cooler, the patient will be able to sleep. An¬ 
other way, and one which also gives to the room a very 
cool appearance, is to place near the window the branch 
of a tree in a tub containing large pieces of ice. 

Ventilation .—Ventilation is pure fresh air displacing 
impure air, and it is the duty of the nurse to see that 
the patient is kept supplied with fresh air. In almost 
every case the window can be kept open I y 2 inches at 
the top without injury to the patient; hot air rises and 
displaces the cold air, which becomes warmed as it de¬ 
scends. If there is a fireplace in the room, a small fire 
may be made, which will direct the impure air up the chim- 


38 PRACTICAL POINTS IN NURSING. 

ney; a lighted lamp or candle will also direct an upward 
current. A board from 4 to 6 inches wide may be placed 
under the lower window-sash, and the fresh air will enter 
between the sashes (Fig. 6), thus preventing a draught. 
Opening the window widely top and bottom, and cover¬ 
ing the patient, who, if afraid of the air, may hold an open 

umbrella before her or 
may have a screen placed 
before the bed, will air the 
room thoroughly; airing 
should be done for a 
few minutes every morn¬ 
ing and evening. Many 
patients will object to the 
window being open at 
night, but the night air 
is purer than that of the 
day. It is said that the 
air in Manchester, that 
great manufacturing dis¬ 
trict—“ the workshop of 
England,” as it is called— 
is purest after 10 p . m., as 
then there is no smoke 
from the immense factory chimneys, and other conditions 
which tend to make the air impure are lacking. There 
should always be removed immediately from the room 
movements, urine, vomited matter, soiled linen, or dress¬ 
ings, as all these.make the air of the room impure. The . 
patient should have all the sun possible. 




































































































































































THE PATIENT. 



III. THE PATIENT. 

I. NURSING IN MEDICAL CASES. 

In reporting to the doctor the nurse must remember 
two things—namely, that he wants facts, not opinions, 
and that he is dependent upon her for a faithful and ac¬ 
curate account of the patient’s condition since his last 
visit; he must be told things just as they are, nothing 
added to or taken from the facts. Many things which 
the nurse may think too simple to report may, to the 
doctor, be very important, and may considerably help 
him in making his diagnosis. The temperature, pulse, 
and respirations must be taken and be recorded on the 
chart. 

i. General Observations in Medical Cases. 

The Pulse.—The pulse, temperature, and respiration, 
which are called the “ three vital signs,” are so closely 
connected that whatever affects one generally affects the 
others. Every time the heart contracts blood is thrown 
into the arteries (see p. 287), which are distended on re¬ 
ceiving the blood ; it is this distention, this rising up of 
the wall of the artery at regular intervals, which corre¬ 
sponds with the beatings of the heart, that is called “ the 
pulse.” 

By taking the pulse we know the number of times 
the heart beats per minute, its fulness, and its regular¬ 
ity. Position and action alter its rate; for instance, it is 
generally faster when standing than when sitting, and 
faster when sitting than when lying; it is slower in sleep 
and faster when dying; it is slower in old age than in mid- 


40 


PRACTICAL POINTS IN NURSING. 


die life, slower in men than in women, faster in children than 
in adults, faster, again, during excitement or exercise. 

Frequency and Varieties of Pulse. —We notice the fre¬ 
quency of the pulse—that is, how fast or how slow it is; 
when we say a pulse is frequent , we mean that it beats 
about from 105 to no times per minute; a rapid pulse 
is from 120 to 140; and a running pulse is above that. 

A pulse is regular when the beats come at regular in¬ 
tervals and are of the same strength ; a full pulse is when 
the beat is strong and long. In an irregular pulse the 
intervals between the beats are unequal, or some beats 
are feebler than the others. A pulse is intermittent when 
a beat is dropped out every few beats, the pulse being 
generally otherwise regular; this pulse may occur in 
health or may be due to some heart trouble or to ex¬ 
haustion. A pulse is compressible when it is easily 
stopped, and incompressible when it is very hard to 
stop; of high tension when the artery seems to be full 
of blood between the beats, and the force of the beat is 
increased and is incompressible; in a low-tension pulse 
the beat is easily compressed. The dicrotic pulse is one 
in which there seems to be two beats, the second beat 
being smaller than the first. There really is only one 
beat, the first one which is counted; the second must 
not be counted, as it is called “ the dicrotic wave,” or a 
secondary wave in the blood-current, not another beat 
of the heart. This fact is very important for the nurse 
to remember; the large beat is to be counted, and not 
the small wave which comes directly after it. If there 
be any difficulty in making the distinction, place one 
hand over the heart, the other at the temple or the wrist, 
and the difference will at once be noticed. 

Taking the Pulse. —The way to take the pulse is to 


THE PATIENT. 


41 


place two or three fingers on the artery at the wrist or 
the temple, and count by tenths of one minute, then mul¬ 
tiply. The thumb must not be placed on the artery, be¬ 
cause there is an artery in the thumb, and the nurse 
would thus be taking her own pulse. 


The pulse in the fetus is about . . 

In the infant at birth. 

At 1 month. 

At 1 year . 

At 2 years. 

At 3 “. 

At 7 “ . 

At 12 “ . 


from 130 to 160 per minute. 

“ 120 to 150 “ 

. . 120 “ 

from 120 to 130 “ 

“ 90 to 115 “ 

“ 80 to 110 “ 

“ 72 to 90 “ 

“ 70 to 76 “ 


This latter rate is the average normal pulse. 

At puberty the pulse is from 80 to 85, because at this 
time the nervous system is more or less excitable; in the 
prime of life, from 70 to 75 per minute ; in old age, from 
60 to 65. In very old age it rises until it is almost as 
high as that of an infant. The normal pulse of some 
persons is rather high, while that of others is as low as 
from 60 to 40. 

Body-temperature.—The normal temperature of the 
body is from 98.5° to 98.6° F., though it may, like the 
pulse, be slightly higher or lower, and be the normal 
temperature for that person. The temperature is higher 
after meals, on account of the activity of digestion; it 
is increased by exercise or by emotion; in children 
or in hysterical patients it is accelerated by excitement. 
Alcoholic drinks will lower the temperature, as will 
also profuse perspiration. It is lowest between 12 and 
4 A. m., and highest between 5 and 8 p. m., because dur¬ 
ing the night we are resting, and the temperature natu¬ 
rally lowers, while during the day food, exercise, and 









42 


PRACTICAL POINTS IN NURSING. 


excitement all tend to increase it. A temperature 
above io8° or below 95 0 F. is generally fatal. The 
temperature of 


Algid collapse is below 95 0 F. 

Collapse is from 95 0 to 9 y° F. 

Subnormal, “ 97 0 to 98° F. 

Normal, “ 984° to 98.6° F. 


Subfebrile, 


u 


99.5 0 to ioi° F. 


Moderate fever is from io.i° to 10.3 0 F. 
High fever, “ 103° to 105° F. 

Hyperpyrexia, “ 106° F. and above. 


Hyperpyrexia generally indicates approaching death, 
when the temperature has been known to rise as high 
as 1 io° F. In a case of tetanus recently seen the ther¬ 
mometer just before death registered a temperature of 
109° F., one hour after death iii° F., and two hours 
after death 112° F. In sunstroke the temperature may 
be 112 0 F. or above. Hysterical patients have been 
known to put the bulb of the thermometer in a cup of 
hot milk or tea, or a hot-water bag, and to shake the 
mercury up, when the attention of the nurse has been 
called to other things, thus producing an alarmingly 
high temperature. 

Subnormal temperatures are observed during conva¬ 
lescence after typhoid fever and pneumonia, when the 
temperature may be subnormal for a few days. It may 
also result from hemorrhage from the lung, stomach, or 
bowel, perforation of the bowel, and from shock. 

The temperature of a child is normal after the first 
week ; at birth it is about 99 0 F. The pulse generally 
rises from eight to ten beats with each degree of tem¬ 
perature; for instance— 


THE PATIENT 


43 

A temperature of 98° F. generally corresponds with a pulse-rate of 60. 


a 

99 ° 

ii 

ii 

a 

70. 

u 

IOO° 

a 


a 

80. 

a 

IOI° 

u 

a 

a 

90. 

a 

102° 

a 

a 

a 

100. 

it 

IO3 0 

a 

a 

a 

110. 

a 

0 

O 

— 

a 

a 

a 

120. 

a 

IO5 0 

a 

a 

a 

130. 

ii 

106 0 

n 

a 

a 

140. 


Ta king the Body-temperature. —The temperature of the 
body is taken with a clinical thermometer (Fig. 7) in the 
mouth, the axilla, the groin, the vagina, or the rectum. 
The temperature of the axilla is about half a degree lower 
than that of the mouth. The temperature of the rectum 
and vagina is about half a degree higher than that of 
the mouth, because these cavities are constantly closed. 

For convenience the temperature is generally taken in 


‘ 1 ■ - '— IH 11 

tth 

III! 

1 iif 

TTTT 

TTTT 

TTTT 

TTTT 

TTTT 

PIT 

1111 

un 

TTTT 

rrn 

TTTT 

irrr 

—=-=\ 



















95 100 

Fig. 7.—Clinical thermometer. 


the mouth. The thermometer is washed in cold water 
and wiped dry, the mercury is shaken down to 95°, and 
the bulb of the thermometer is placed under the tongue 
and the lips kept closed for five minutes. The patient 
must be told not to open the lips while the temperature 
is being taken, or cold air will enter the mouth and 
the instrument will register a temperature lower than it 
should. Hot or cold drinks given immediately before 
taking a temperature in the mouth will make the re¬ 
corded temperature higher or lower than it really is. 

The temperature of very weak patients, unable to 
keep the mouth closed, and of unconscious and delirious 
patients, should be taken in the axilla or the rectum. 


























44 


PRACTICAL POINTS IN NURSING. 


The clothing is removed from under the arm, the arm- 
pit is dried from perspiration, the bulb of the thermome¬ 
ter is placed between the folds of the skin of the armpit, 
the elbow is bent, and the arm is held close to the side, 
the hand touching the opposite shoulder. The ther¬ 
mometer should remain in the axilla from seven to ten 
minutes. Before taking the temperature in the rectum 
the latter must be emptied if full, or the thermometer 
will become imbedded in the fecal matter and will not 
come in contact with the mucous membrane. The ther¬ 
mometer is oiled and inserted for about ij inches, and is 
allowed to remain five minutes. The same length of 
time is allowed for taking the temperature in the va¬ 
gina. 

Fevers are said to end by lysis or by crisis. By lysis 
the temperature falls gradually, as in typhoid fever, while 
crisis is a sudden fall to normal, as in pneumonia. A 
sudden rise or fall must always be reported promptly, as 
some complication has probably set in, though with hys¬ 
terical patients the temperature may rise to 103° F. or 
above, and fall, without indicating anything serious. The 
same is also true of children. Very little things will 
often cause in a child a rise of temperature, which falls 
in a short time, so that a high temperature in a child is 
not so serious as that in an adult. 

Respiration.—The normal number of respirations in 
an adult are 16 to 18 per minute; we breathe once to 
four beats of the heart. With man the breathing is 
abdominal } and with women it is thoracic. When taking 
the respirations one should notice if they are regular or 
irregular, frequent, quiet, deep, shallow, thoracic, or 
abdominal. The respirations can be counted by watch¬ 
ing the rise and fall of the chest after having taken the 


THE PATIENT 


45 


pulse, the fingers being still on the wrist. The most 
accurate way is to lay the hand lightly on the chest, but 
there is the danger of the patient breathing slower or 
faster when he knows they are being counted. It is 
always best to count the respirations when he is asleep, 
as they are then slower, but natural; excitement and 
exertion increase them. The respirations in 

Infants are about.from 30 to 35. 

At the fifth year .“ 20 to 25. 

“ “ eighth year . . . the same as those of an adult. 

The Cheyne-Stokes respiration is a very peculiar form of 
breathing. The respirations gradually increase until they 
reach a certain height; then they gradually decrease until 
they entirely cease for a few moments, when they begin 
again in the same order. The Cheyne-Stokes respiration, 
which usually occurs in certain diseases of the heart, brain, 
or kidneys, is a fatal symptom. 

The pulse, temperature, and respirations must accu¬ 
rately be recorded on paper or on a chart; when there 
is any doubt as to their correctness, a question-mark 
should be made, so that the attention of the attending 
physician will be drawn to the record. A patient must 
not see her temperature chart or even be informed of 
the run of her temperature, because if the fever con¬ 
tinues the patient becomes depressed. If unusual symp¬ 
toms have developed, it is a good plan to leave a note 
downstairs for the doctor informing him. 

Observation of Symptoms.—The accurate observa¬ 
tion of symptoms in the cases which a nurse will have 
under her care is of the utmost importance, so that she 
may know how to give the doctor a faithful and accurate 
account of everything that has happened since his last 
visit. 




46 


PRACTICAL POINTS IN NURSING. 


Position. —Notice must be taken of the position the 
patient assumes when lying in bed, because he always 
takes a position which gives him the most comfort. A 
patient ill with peritonitis lies on the back with the knees 
drawn up, to relax the muscles of the abdomen; one ill 
with pleurisy or asthma will breathe much easier when 
propped up. If one lung is affected, the patient will 
generally be found lying on the affected side, so that the 
sound lung can work better. Again, when a patient has 
been very ill, and has been lying on the back continually, 
it is a good sign when he turns over on the side. 

Nausea and Vomiting. —Under all circumstances nau¬ 
sea and vomiting must be reported, and the following 
symptoms of the condition be noted: Is the patient con¬ 
tinually nauseated without vomiting, or does the vomit¬ 
ing occur soon after taking medicine or nourishment? is 
the color of the ejected matter green, as it may be in 
any case where there is straining ? does it contain blood, 
as in hemorrhage from the stomach ? is it fecal or dark 
like coffee-grounds, such as we get in intestinal obstruc¬ 
tion ? or are the contents of the stomach rejected with¬ 
out any distress or nausea? 

Food. —A record should be kept of the exact amount 
of food the patient takes: Does he like or dislike it? is 
there a craving for other food than that he is taking ? is 
there any difficulty in swallowing ? 

The Mouth. —The state of the mouth should be ob¬ 
served : Is there any pain ? is the mouth hot ? are the 
teeth decayed or unclean ? The condition of the gums 
should also be examined: are they a normal red or very 
pale, swollen, bleeding, or rather blue ? 

The Tongue. —The condition of the tongue should be 
noted : Is it coated ? if so, is the color light, the coat gray, 


THE PATIENT. 


47 


dry, and brown, as seen in typhoid fever, or is the tongue 
red like beef, or of the so-called “ strawberry-tongue ” 
type, which is rather peculiar, having a white fur through 
which project bright red dots or points ? This form is 
seen in scarlet fever. Another condition of the tongue 
to be noticed is the trembling which accompanies typhoid 
and other fevers. 

Pain. —In reporting pain, which is a condition that can 
neither be heard nor seen, the nurse can tell the doctor 
only what the patient says respecting the location of the 
pain and its character—throbbing, steady, or a shooting 
pain, and so on. 

Facial Expression. —The expression of the face must 
carefully be watched: Is it anxious and pinched ? does 
the patient seem to take an interest in what is going on ? 
or is he dull and listless ? Are there hot flushes of the 
face, paleness, blueness (commonly called “ cyanosis,” 
which is caused by insufficient oxygen in the blood) ? 
or does the color come more in one cheek than in the 
other ? 

Co 7 igh and Expectoration. —The nature of the cough 
and expectoration must be determined: Is the cough 
hard and dry, without expectoration, or moist, loose, 
or hacking ? does it tire the patient to cough ? and does 
he cough more when lying upon his back than upon his 
side ? and upon which side ? or does the attack come on 
in paroxysms or fits of coughing? The expectoration 
may be frothy and watery, rusty, and adhere to the vessel; 
it may be the color of prune-juice, as is seen in gangrene 
of the lung, and have an offensive odor; it may also re¬ 
semble pus; it may be streaked with blood, or be thick 
and yellow. The expectoration should always be saved 
for the doctor’s inspection and its character and quantity 


48 


PRACTICAL POINTS IN NURSING. 


noted. Line a sputum-cup (Fig. 64) with paper, which 
can be taken out and burned and the cup boiled. This 
should be done at least three times a day, especially in 
infectious diseases, such as pneumonia and consumption, 
where the germ leaves the body through the expec¬ 
toration. 

The Breath .—The character of the breath should be 
observed: Is its odor sweetish like chloroform ? or has 
it a fetid odor caused by decayed teeth, dyspepsia, con¬ 
stipation, etc. ? 

Sleep must be noted: Is it quiet and restful ? or does 
the patient sleep all night and awake very tired, entirely 
unrefreshed ? at what time did she fall asleep, and how 
long did she sleep? was it in the first or the latter part of 
the night ? or would she fall asleep and awake at intervals, 
and remain awake for a few minutes, an hour, or a few 
hours, then drop off to sleep again ? was she restless 
when asleep? Notice whether the patient is hard to 
waken; is there twitching of the muscles during sleep, 
muttering, or any sign of delirium ? 

The character of the breathing'. Was it quiet, deep, 
shallow, rapid, regular, irregular, or snoring (stertorous), 
with flapping out of both cheeks, or of one cheek more 
than the other ? This condition must always be reported 
promptly, as it generally denotes unconsciousness. 

Delirium .—Note the kind of delirium : is it quiet and 
busy; muttering; picking at the bed-clothes or at 
imaginary objects; or violent; if so, when is it most 
violent? Patients are very often quiet during the physi¬ 
cian’s visit; indeed, they seem to know the instant he 
enters the house. They are, as a rule, very cunning, 
and must not be left alone for a single moment, no mat¬ 
ter how mild the delirium, as they may get out of bed 


THE PATIENT 


49 


and harm themselves, or may even jump out of the win¬ 
dow. Terrible accidents have happened through delir¬ 
ious patients being left alone; hence the nurse should 
always remain near a delirious patient until some one 
can relieve her. 

Chills .—In reporting a chill there should be given the 
time it occurred, how long it lasted, and the temperature, 
pulse, and respirations. As very many diseases and com¬ 
plications begin with a chill, it is very necessary that 
a chill should be reported at once. It may vary from a 
mere chilly feeling to a violent shivering or chattering of 
teeth; even the bed may be shaken. A chill may be 
divided into three stages: first , the cold, shivering 
stage; second , the hot stage, during which, if the tem¬ 
perature be taken, one will find it elevated, often in se¬ 
vere cases from 104° to 106° F. The second stage passes 
into the third , the stage of perspiration. For the first 
stage the nurse should apply heaters well covered, 
extra blankets, and give hot drinks of any kind—hot 
milk, tea, coffee, or cocoa; for the second she should 
gradually remove the heaters and extra covering; and 
for the third the patient should be wiped dry under 
the bedclothes with warm towels. If the perspiration 
is very profuse, the clothing may be changed, but the 
nurse must be sure that it is thoroughly aired and 
warmed before changing, thus guarding against another 
chill. 

The Skin , etc .—The color of the skin must be noted, 
its pallor, blueness, or yellowness; any discoloration, 
hardness, or edema, which is a watery swelling caused 
by a collection of serum in the cellular tissue, and 
which pits on pressure; note if the skin is hot and 
dry, or if there are hot flushes of the head and face, suc- 
4 


50 


PRACTICAL POINTS IN NURSING. 


ceeded by creeping chills down the spine alone or over 
the whole body; also, the condition of the nails : are they 
discolored, blue, dry, and brittle? Is there any dis¬ 
charge from the nose, the ears, or the eyes ? 

The Bowels .—The condition of the bowels must care¬ 
fully be watched, noting if there is constipation or 
diarrhea; also the color of the movements. Black 
movements follow the use of certain medicines, such 
as bismuth, iron, charcoal, and tannin. When hemor¬ 
rhage has taken place and the blood has been retained 
in the bowels, as will sometimes occur in typhoid fever, 
the movements are then of a black or tarry color, but 
when the hemorrhage has occurred and the blood passes 
immediately from the bowels, the color is very little if 
any changed, and the movements are of a red color. It 
should be noticed if the feces contain mucus or pus, 
undigested food, or even pills which may pass through 
the bowels without being dissolved. The patient may 
have diarrhea accompanied by the so-called “packed” 
feces—that is, the bowels are packed with small, round, 
hard lumps like marbles; the movements are then fre¬ 
quent and watery or contain these small lumps, and still 
the bowels may not be emptied. This condition must 
be reported, and whether the movements are attended 
with pain. Pain, tenderness, and distention of the abdo¬ 
men, also flatulence, must be reported. The passage of 
gas by the rectum after an abdominal operation is a very 
good sign. 

The Bladder: Urine .—The condition of the bladder 
must be recorded : is the normal amount of urine passed, 
or is the amount decreased or increased ? is there reten¬ 
tion, suppression, or a constant dribbling of urine (incon¬ 
tinence) ? is there a constant desire to urinate, and is the 


THE PATIENT. 


51 


urine passed with difficulty or pain ? Anything abnor¬ 
mal in the color, odor, etc. of the contents of either 
bowels or bladder must always lead the nurse to save 
a specimen for inspection. 

A specimen of the morning urine should always be 
saved for examination, because the secretion has not 
generally been influenced by food or medicine, and a 
better knowledge is obtained as to its specific gravity 
and the amount of solids excreted. The urine must be 
drawn with a glass catheter into a clean bottle or a 
tumbler, and be labelled with the name, date, quantity, 
and hour that it was drawn. The bottle must be cov¬ 
ered tightly and placed in a cool place, because warmth 
increases the acidity of the urine, the color becomes 
high, and the normal cloud settles to the bottom. In 
hot weather the reaction may change to alkaline and 
the color become pale. 

The general points to be noted about the urine are the 
amount passed during the twenty-four hours; its odor, 
color, and appearance; whether perfectly clear or cloudy; 
the time the urine was passed, its reaction and specific 
gravity. It must be noticed whether there is retention 
or suppression of urine: is the urine passed with pain or 
in very small quantities ? does it contain blood or pus ? 
To record the twenty-four hours’ amount, the excretion 
should be taken from 6 a. m. to 6 p. m. and from 6 p. m. 
to 6 a. m., and both amounts be added together. When 
the bladder is very full, it must not be emptied at once, 
but one part must be drawn off, and the other later on, 
as sudden emptying of the bladder would bring the walls 
together, and inflammation or cystitis might set in. 

Hiccough and the periods of its occurrence must be 
reported. It is a spasmodic contraction or movement 


52 


PRACTICAL POINTS IN NURSING. 


of the diaphragm, and may come on after eating or drink¬ 
ing, on account of nervousness, or when there is great 
exhaustion following acute diseases. Sometimes hot 
drinks, or holding the breath for a few seconds or as 
long as possible, will relieve hiccough. 

Menstruation .—Report menstruation, the amount and 
regularity: does pain come before, with, or after the flow 
begins? and does it last a few hours, one or two days, 
or does it last all through the period ? Also report the 
locality and character of the pain; the character of the 
flow, whether it is of a normal color and odor, or scanty, 
dark, or pale, and, if clots come away w'ith it, their number 
and size. If there is any leucorrhea, the character and 
quantity should be noted : is it profuse, thick, and stringy, 
or does it resemble the white of an egg ? Leucorrhea is 
not a disease, but is generally a symptom of inflamma¬ 
tion of the vagina or the lining membrane of the uterus. 

2. Bodily Care of the Patient. 

Changing the Clothing.—To change the nightdress 
and undershirt, they are loosened at the neck and wrists, 
and brought well up under the shoulders on one side of 
the patient; the arm is taken out of the soiled garments, 
and the corresponding clean sleeves are put on, and both 
sets of garments slipped over the head; this slips the 
soiled shirts off and the clean shirts on. The nurse 
now goes to the other side of the bed, removes the 
soiled clothing, and puts on the sleeves of the clean 
clothing, raising the patient slightly and pulling the 
clothing down smoothly at the back. It is generally 
well to have the body-linen open all the way down 
the front, and to button or tie it with tapes. Where 
one side is injured or paralyzed, the clothes should be 


THE PATIENT. 


53 


taken off at the sound side first , and be put on at the 
injured side first; this will save the patient a good deal 
of unnecessary pain. Should one or both arms be frac¬ 
tured, the sleeves can be opened from wrist to neck and 
tapes be stitched on either side from 4 to 6 inches 
apart; the arm is then raised, the sleeve placed under, 
and the tapes tied. 

Toilet of the Patient.— The Hair .—The hair must be 
combed every day, and be braided in two braids: if it is 
done up in a tight knot at the back of the head, the 
patient has a hard lump to lie on. If the hair is much 
matted through neglect, it must be gently combed, a little 
at one time, not jerked. The nurse will find it easier to 
comb upward. She must not tire herself and the patient 
by trying to comb it all at one time, but must do one part 
and leave the other until later in the day. If vermin are 
in the hair, tincture of larkspur, which is about the best 
exterminator to use, or carbolic acid (1 :40), or kerosene 
oil, should be rubbed into the hair, and the head be 
wrapped in a towel or cloth for two or three days. 
When the hair is dry, the nits can be destroyed by 
very thoroughly rubbing it with alcohol. 

The Mouth .—The patient’s mouth should be attended 
to each day punctually. The mouth, to be kept perfectly 
clean, should be washed at least three times a day, and 
the teeth carefully brushed. Nothing is more refreshing 
in illness than a clean mouth and well-brushed teeth. If 
the patient has no tooth-brush, a piece of cotton wrapped 
around the end of a toothpick or a matchstick will serve 
to clean the teeth with. 

The nails must be cleaned and trimmed if necessary. 
The hands and face should be bathed and the teeth 
brushed just before settling down for the night. 


54 


PRACTICAL POINTS IN NURSING. 


The Body .—The nurse should be careful to keep the 
bed- and body-linen perfectly dry and free from wrinkles, 
and the bed free from crumbs, and should guard against 
bed-sores , which are generally the result of careless 
nursing in allowing continued pressure upon the promi¬ 
nent parts of the body, except in cases such as those 
of fractured spine resulting in paralysis, and where the 
nerve-supply is injured, when bed-sores will form under 
the best of care. It must not be forgotten that a bed¬ 
sore is a disgrace to a nurse, except, of course, in these 
exceptional cases, and every good nurse will do all in her 
power to prevent it. She must not wait for redness to 
appear before beginning to bathe the back. Alcohol in 
any form, cologne, vinegar, or lemon-juice, may be used 
to harden the skin; and there may be used to powder 
the back oxid of zinc, powdered laundry starch, corn¬ 
starch, baby-powder, bismuth, or borax. In the absence 
of alcohol and powder the sheets should be kept perfectly 
dry and free from crumbs and wrinkles, the parts be kept 
clean, and pressure be removed by pads and rings made 
of oakum, muslin, sheet-wadding or compress, and wound 
round with a bandage (Fig. 3). The patient’s position 
should frequently be changed. If there is much moisture, 
the back may be rubbed with any kind of oil, sweet oil, 
mutton-tallow, lard, or even melted candle, any one of 
which will prevent the moisture from being absorbed. 
There are some patients so very thin and emaciated that 
bed-sores form notwithstanding all the care that can be 
taken. Should one form, the pressure must be removed 
with a ring, the part painted with the white of an egg, 
which will be the next best application to collodion and 
will exclude the air, or be dressed with oxid-of-zinc- 
ointment. If the nurse is at a distance from an apothe- 


THE PATIENT. 


55 


cary store, and has oxid-of-zinc powder and pure lard, 
four parts of the lard should be mixed with one part of 
powder; the regular ointment is prepared with benzoated 
lard, but the nurse may use common lard in an emergency. 

Baths.— Foot-bath .—It is only the work of a few min¬ 
utes to give a foot-bath : everything should be made 
ready, the upper bed-clothes then loosened at the foot 
of the bed, and across the lower part is spread a rubber, 
newspapers, or a soiled sheet, on which the foot-tub or a 
large basin is placed. The patient puts her feet in the 
tub, and the nurse draws the upper clothing around the 
limbs to protect them from cold. After the bath the 
nurse should see that the feet are properly dried; if they 
are cold, a well-covered hot-water bottle may be put to 
them. 

Sponge-bath .—To give a sponge-bath to a patient in 
bed, the nurse first gets everything ready, and sees that 
the fresh clothing is thoroughly aired; the patient is then 
wrapped in a blanket, the clothing removed, and one 
part bathed at a time. She begins with the patient’s 
face and neck, then the chest, abdomen, and arms, then 
the back, bathing the lower extremities last of all. The 
water should be changed at least three times, and the 
patient have the full benefit of the water as far as possi¬ 
ble ; the arms, the legs, and the feet placed in the basin 
and bathed thoroughly. Care must be taken not to 
expose more than one part at a time. 

It will be found that some of the patients in private 
practice will take a sponge-bath every day, while others 
will take one only once a week. The nurse must go 
according to the inclinations of the patient, unless, of 
course, the physician should otherwise order. 

Tub-bath .—When a tub-bath is ordered, and there is 


PRACTICAL POINTS IN NURSING. 


56 

no bath-tub, a wash-tub will answer, the patient being 
seated in it and pailsful of water poured over the body. 

The Bed-pan .—When inserting a bed-pan the patient 
should be requested to raise herself a little; the nurse then 
puts her hand under the patient’s back and inserts the 
pan : if this method is followed, the pan will rub against 
the back of her hand, thus preventing the patient’s back 
becoming irritated and a bed-sore forming. The nurse 
should raise the patient when removing the pan; it must 
not be dragged out: if the patient is very heavy, some 
one may be asked to assist in lifting her on and off the 
pan, which must first be warmed, to prevent chilling the 
patient, either by holding the pan over a register or by 
pouring over it warm water. 

Feeding- of the Patient .—Serving the Meal .—At 
meal-times the nurse should have the napkin and tray- 
cloth spotless, and the china, glassware, and silver of 
the best that the house affords ; hot food should be 
served hot , not lukewarm, and cold food and cold drinks 
cold. It is better to serve too little than too much, and 
there should be a variety. Plenty of time should be 
allowed for the meal; the patient must not be hurried, 
so that the food can be thoroughly masticated and mixed 
with the digestive juices. The liquid must not be spilled, 
nor must a tumbler or cup be held at the rim where 
the patient is going to drink, but it should be held at the 
bottom. The tray must be removed when the meal is 
over, and if the patient has left anything to eat later, 
it should be put away, and on no account be left in the 
room. It is perhaps needless to add that the nurse’s 
hands must be washed before preparing the food, also 
the hands of the patient before each meal. 

Feeding Feeble Patients .—The principal thing to ob- 


THE PATIENT. 


57 


serve in feeding a feeble patient is to feed often and a 
little at a time. One will be astonished at the end of the 
day to find how much nourishment a patient has taken 
by giving it in small quantities every ten or fifteen minutes, 
gradually increasing the amount of the food and length¬ 
ening the intervals between the meals. Milk (which must 
be fresh and pure, and to which can be added the white of 
an egg), gruel, beef-tea, oyster-broth, raw oysters (which 
are very nourishing and easily digested), and eggnog, may 
all be given (see Dietary, p. 315); as the patient gains 
strength the food may be gradually changed to soft solids. 
When feeding an unconscious patient pass the spoon far 
back into the mouth, empty it slowly, and then close the 
lips and nostrils; the patient will involuntarily swallow. 
Milk and brandy dropped on the tongue will be absorbed. 
When feeding an unconscious patient by rectum the 
enema should be given as high up into the intestine as 
possible, so that the fluid will be injected into the colon 
rather than into the rectum, because, according to some 
authorities, absorption goes on very slowly from the 
rectum, but very rapidly from the colon itself. Both 
the colon and rectum must be free from feces before 
the enema is injected. 

When supplying a patient with ice to suck, a piece of 
flannel or of cotton should be laid over the top of a 
tumbler, and a dent made in the centre in which to put the 
small pieces of ice; then as the ice melts the water drops 
into the tumbler, and the ice keeps much longer than it 
would if allowed to stand in the water. 

Moving of the Patient.—The nurse should never 
attempt to lift a helpless patient alone: she should ask 
some one to help, nurse and assistant standing at the same 
side of the bed. The nurse places one arm under the 


58 


PRACTICAL POINTS IN NURSING. 


neck of the patient; this brings the head resting on her 
arm, her hand being passed under the arm on the other 
side; the other hand and arm are passed under the 
middle of the back. The assistant passes one arm under 
the lower part of the back and the other under the knees, 
and both lift the patient toward the head of the bed. If 
a limb is injured, a second assistant will be needed to 
support the limb above and below the seat of injury. 

A patient can be moved from one side of the bed to 
the other by the nurse placing one hand and arm down 
the patient’s back, thus supporting the head and shoul¬ 
ders, and by passing her other hand over and slipping it 
under the upper part of the back ; the upper part of the 
body can then be moved to the fresh side of the bed. 
The nurse’s hands are then placed, one under the lower 
part of the back and the other under the knees, and the 
lower part of the body is lifted over. Or the under sheet 
can be secured to the mattress with safety-pins, the draw- 
sheet loosened, and the patient on the draw-sheet be 
drawn to the fresh side of the bed ; the draw-sheet being 
then replaced. The best way is to have two beds of equal 
height, one for day and one for night, each having its own 
set of bedding; when changing the patient the beds are 
placed side by side, the nurse taking the sheet at the 
head, an assistant at the foot; the patient in this way is 
lifted to the fresh bed without jarring. If the patient is 
very heavy, an assistant will be needed at each corner, or 
if there are broken limbs, other assistants will be needed 
to support the limbs. If alone, the nurse should loosen the 
under sheet, gather in her hands the side nearest to her 
top and bottom, and draw the patient to the fresh bed. 
When two beds cannot be obtained, a sofa or a lounge 
may be used for the daytime. If the patient is in a large 


THE PATIENT. 59 

double bed, one half of it should be kept for the day, the 
other half for the night. 

It needs two persons to carry a patient, and this is 
done by each grasping the forearms of her companion 
at the patient’s back and under the knees, thus forming a 
chair, the patient resting an arm on the shoulder of 
each; but a much better way is to improvise a 
stretcher by rolling two long broom-handles or poles 
tightly in each side of the under sheet; in this way, with 
an assistant at the head and foot, the patient may be car¬ 
ried steadily to any part of the room or the house. The 
nurse must first make sure that the under sheet is good 
and stout, or she may have an accident by the sheet 
tearing and the patient falling. 

To carry a baby, one arm is passed downward under 
the shoulders, with the head resting on the upper 
part of the arm; the other arm is passed under the 
knees, the lower part of the back resting on the hand. 
A child should never be carried with one arm around 
the neck, the other under the knees, thus allowing the 
body to sink between the arms and the head to hang 
down over the arm. One will readily see that by carry¬ 
ing a child in this way the blood is apt to leave the brain 
and go to the abdomen. The head must always be 
supported. 

3. Relief of Functional Disturbances. 

Enemata.—An enema is a liquid preparation for in¬ 
jection into the rectum, and is given to relieve constipa¬ 
tion or to check diarrhea; to give nourishment, stimu¬ 
lants, or medicines when they cannot be retained by the 
stomach; to relieve the bowels of flatulence; and for 
other purposes. For all large enemata a Davidson or 


6o 


PRACTICAL POINTS IN NURSING. 


a fountain syringe should be used, and a hard-rubber 
syringe for small enemata. After being used the syringe 
must be cleansed by running hot soapsuds, and after¬ 
ward hot water, through it, the outside wiped dry, and 
the instrument hung up to drain. If a hard-rubber 
syringe leaks and is not tight enough, filling it with 
water and leaving it full will cause the washer to swell 
and fit tightly; it always shrinks when not in use, and 
for this reason it is always well to soak rubber syringes 
every other day or so, that they may always be ready 
for use. 

Evacuant Enema .—A simple enema, to relieve the 
bowels, is of soapsuds, made with castile or brown soap; 
the amount of warm water varies from one to three 
pints. A sheet or rubber sheet should be placed under 
the patient, who should lie upon the left side with the 
knees drawn up, or upon the back. Both ends of the 
syringe should be put in the water, and the air expelled; 
the tube is oiled, and also the first finger of the nurse’s 
left hand, which is passed under the clothes to the rec¬ 
tum, the finger acting as a guide. With the right hand 
the tube is inserted, as gently as possible, upward and 
slightly backward, following the natural curve of the 
rectum ; the tube is held in place with the left hand 
and the injection slowly made with the right. If there 
is any difficulty in inserting the tube, it should be re¬ 
moved. No force is to be used; the resistance may be 
caused by the rectum being packed with fecal matter 
(which can be removed with the fingers), or obstructed 
by hemorrhoids (piles) or other obstacles. 

Should the enema give pain to the patient, the nurse 
should rest a few moments until the pain has passed 
away; then the injection can generally be continued 


THE PATIENT. 


61 


until all the fluid has been given. The tube is gently 
removed, and to the anus is placed a folded towel, 
which will apply pressure and help the patient to retain 
the enema a few minutes. The result must always be 
accurately reported. If there is no result from one 
enema, it is safe to repeat it in half an hoiy*. 

High Enema .—A high enema is an injection of fluid 
high up in the bowels in cases of obstinate constipation. 
There are needed a rectal tube and a soft-rubber catheter, 
or a piece of rubber tubing which is connected with the 
tube of the syringe and inserted up the rectum about 8 
inches. If there is no rectal tube or rubber tubing, and 
the nurse has a fountain syringe, the hard-rubber or 
metal tip can be taken off, and the soft tubing will 
answer. If the syringe is a Davidson, the patient’s head 
is lowered, the hips raised by placing a pillow under them, 
and the foot of the bed is also raised as high as possi¬ 
ble on chairs. This position of the patient will send the 
flow higher up in the bowel, as will also the knee-chest 
position (Fig. 34; seep. 140). When the tubing is used 
there is always the possibility of its coiling up inside the 
rectum. Should the nurse suspect this, she should insert 
a finger, and if a coil is found, the tubing should be 
drawn out a little, then inserted again. 

Purgative Enemata .—An enema of olive oil or castor 
oil is to soften the feces. Six ounces of oil are warmed 
and injected as high as possible, this injection being 
followed in half an hour with an enema of 1 quart of 
soapsuds. 

For a glycerin enema from \ an ounce to 2 ounces of 
glycerin are mixed with the same amount of warm soap¬ 
suds. In many poor families the nurse may not find 
olive oil, castor oil, nor glycerin, in which case either 


62 


PRACTICAL POINTS IN NURSING. 


vaselin, butter, or lard melted and strained before inject¬ 
ing may be used. 

If a turpentine enema is ordered, I ounce of turpen¬ 
tine added to 3 ounces of warm water, is given first, 
followed with an enema of 1 pint of soapsuds. 

Rochelle salt and Epsom salt (sulphate of magnesia) are 
each given as a purgative enema, 1 ounce of the salt and 
1 ounce of turpentine being mixed with 1 pint of warm 
soapsuds. 

Molasses is an excellent purgative: from 2 to 10 
ounces are mixed with 1 pint of soapsuds, or the mo¬ 
lasses heated will readily pass through the syringe, the 
molasses enema being followed in half an hour with a 
soapsuds enema. 

Enemata that have been used with success are— 

1. Glycerin, 4 ounces, 

Turpentine, I ounce, 

Warm soapsuds, 8 ounces. 

2. Molasses, 2 ounces, 

Glycerin, 4 ounces, 

Magnesia sulphate, 1 ounce, 

Turpentine, 1 ounce, 

Warm soapsuds, 8 ounces. 

3. Rochelle salt, 2 ounces, 

Turpentine, 1 ounce, 

Warm soapsuds, 1 pint. 

Astringent Enema. —A starch-and-landamim enema is 
to check diarrhea. The starch is prepared as for laundry 
use, except that it should be thin enough to pass through 
the syringe; then the quantity to be used is measured, 
which is usually 2 \ or 3 ounces, and there is added 30 
drops of laudanum, this being the usual quantity or- 


THE PATIENT. 


63 


dered. The enema is to stand until lukewarm before 
being injected. 

BlandEnemata. — Barley, flaxseed, oatmeal, and Indian- 
mealenemata are very soothing to an irritated membrane. 
They are each made thin enough to pass easily through 
the syringe, and must be strained before being injected. 

Stimulating Enemata.—A salt enema is given for a 
stimulating effect: 1 ^ teaspoonsful of common salt are 
dissolved in 1 quart of hot water. Other stimulating 
enemata are black coffee, half a pint (to be strained be¬ 
fore injected); plain hot water; or whisky or brandy, 1 
ounce added to 2 ounces of hot water. If there is no 
brandy or whisky at hand, but there is pure alcohol, 
only one-half this amount should be given, because the 
spirits are only half as strong as pure alcohol, but of the 
same strength as diluted alcohol, the wines, port and 
sherry, being still weaker; so where the nurse is di¬ 
rected to give 4 teaspoonsful (half an ounce) of brandy 
or whisky, she should give the same amount of diluted 
alcohol, or 2 teaspoonsful of pure alcohol, or 1 ounce of 
the wines. 

If the pulse becomes nearer normal, the temperature 
lower, the patient quieter, and an improvement takes 
place, the nurse will know that the stimulants are doing 
good ; but if the face becomes flushed, the pulse full and 
bounding, and the restlessness increased, she will know 
that they are not doing good, and must be stopped and 
the physician be notified. 

A stimulating nutritive enema generally consists of— 
Milk, 4 ounces, 

Whisky, \ ounce, 

Tincture digitalis, 10 or 15 minims, 

the enema being injected high up in the bowel. 


64 


PRACTICAL POINTS IN NURSING. 


Rectal Feeding-.—Nutritive enemata must be injected 
as high up into the intestine as possible, because the colon 
absorbs more quickly than the rectum, and if the enema 
is not given high it is very apt to remain in the lower 
bowel, and is incompletely absorbed when the second 
one is given; as a result the second and part of the first 
are rejected. 

A nutritive enema consists of— 

Milk, 4 ounces, 

Whisky, ^ ounce, 

White of egg. 

Or, Milk, 4 ounces, 

and one egg. 

Beef-tea, beef-juice, liquid foods, extracts of beef, 
cream, and oyster-broth are given per rectum. Stimu¬ 
lants are very irritating to the mucous membrane, and 
for this reason they should not be put into every enema, 
but only into every other one. The nurse should report 
whether the enema is or is not retained, also as to the 
presence of food in the movements. 

A nutritive enema must not be given oftener than once 
in every three or four hours, and must not exceed from 
4 to 6 ounces each time, unless differently ordered by the 
physician. A cleansing enema of warm water must be 
given first, to clean the bowel and to prevent irritation 
of the mucous membrane. 

If the patient is very weak and does not retain the 
enema very well, it is a good plan to plug the bowel 
with soft linen or gauze, the end inserted having first 
been oiled. This measure will prevent the enema from 
being returned. 


THE PATIENT 


65 


Douches.—A douche is a stream of water directed 
against a part for cleanliness, for stimulation, and to re¬ 
lieve inflammation or hemorrhage. Three of the com¬ 
monest douches are the aural, the vaginal, and the rectal. 

Vaginal Douche .—The vaginal douche is generally for 
cleansing purposes and to relieve inflammation. The 



Fig, 8.—Apparatus for vaginal douche. 


surgical antiseptic douche is for cleansing purposes, 
from 1 to 3 quarts of warm water being used. The 
gynecological hot douche is to relieve inflammation. 
The amount of water used is from 5 to 6 quarts, begin¬ 
ning with a temperature of no° F., and gradually in¬ 
creasing it each day until it reaches 119 0 F. The tem¬ 
perature must always be tested with a bath-thermometer. 

The Baker douche apparatus (Fig. 8) is the best to 
use, as the pail and pan each hold five quarts of water, 
and the patient can lie in the proper position for the 
fifteen minutes required for the water to run out of the 
pail. 


5 















































































66 


PRACTICAL POINTS IN NURSING. 


When taking a douche the patient should lie on her 
back, with the hips raised by means of a pillow and the 
knees drawn up. In this position the water comes in 
contact with the whole vagina, for it is for the womb and 
ovaries that a douche is given, and if taken sitting over 
a vessel the water runs down by the side of the tube as 
fast as it runs in, the water reaching only as high as the 
nozzle. 

The fountain syringe, when used, must be hung high 
enough over the bed for it to take fifteen or twenty min¬ 
utes for the water to run out of the syringe. Air must 
be expelled, the tube oiled, and the water must run warm 
before the tube is inserted into the vagina. 

The vagina being a curved and not a straight canal, 
the tube must be inserted slightly downward, then up¬ 
ward. Again, the injection does not flow into the womb, 
as many think: if one will study a vaginal tube with the 
three small holes pierced in its sides, it will be seen that 
the injection is not intended to enter the womb, but is for 
the surrounding parts; if a few drops of water should 
accidentally enter the uterus, there would follow a severe 
attack of uterine colic. A hard-rubber tube is the best, 
as glass or metal will burn the parts, though a glass 
nozzle can be rendered aseptic more thoroughly than 
one of any other material. 

All have noticed how red and swollen the hands be¬ 
come on putting them into hot water, caused by the 
blood-vessels dilating and bringing more blood to the 
parts; then after a while the vessels contract and the 
blood is driven away, and the hands have a wrinkled 
appearance, commonly called “ washerwoman’s hands.” 
A vaginal douche given to relieve inflammation has ex¬ 
actly the same effect. The hot water dilates the blood- 


THE PATIENT. 


6? 


vessels and brings more blood to the parts; then, on 
continuation of the hot water, the vessels contract, the 
blood is driven away from the parts, and the inflamma¬ 
tion is subdued. The nurse will therefore see why she 
must be faithful in keeping up the douches as ordered, 
giving them at the proper time and temperature and 
length of time. A patient should lie quietly for half an 
hour after taking a douche; if she is taking only one a 
day, it is best to give it at night, because then the womb 
is most congested and needs the hot water most, and 
the temporary weak feeling which follows a douche will 
be gone before morning. However, the nurse should go 
according to the orders given by the physician. 

Many patients object to taking douches, and will 
neglect them on account of the inconvenience, especially 
if they live in apartments and there are children in the 
family; but this can be overcome by taking them in the 
bath-tub. Halfway across the bottom of the tub there 
is made to fit a piece of board, on which the patient can 
lie. Douches are easily taken in this way, which obvi¬ 
ates a great deal of annoyance. 

Antiseptic Douches .—Corrosive sublimate, carbolic acid, 
creolin, and boric acid are used for antiseptic douches. 
Corrosive sublimate and carbolic acid are very poisonous. 
Creolin is irritating, and to prevent absorption and irrita¬ 
tion a plain water douche is often ordered to follow any 
of these antiseptics when a strong solution has been 
used. 

Rectal Douche .—Rectal douches are for cleanliness 
and to relieve inflammation. Hot rectal injections to 
relieve inflammation are given with a fountain syringe 
and a rectal tube. The patient lies on her back with the 
knees drawn up, and a small pillow is placed under the 


68 


PRACTICAL POINTS IN NURSING. 


hips to direct the flow upward. The physician will give 
directions as to the amount of water to be used, its tem¬ 
perature, etc. 

Douches to the external genitals, to the perineum, or 
to the anus for the relief of inflammation or hemorrhoids 
may be given with the patient in the sitting position and 
with an ordinary rectal tube. The force of the stream 
and the temperature of the water are decided by the 
physician. 

Catheterization.—Before catheterizing a patient great 
care must be taken in cleansing the hands, the catheter, 
and the parts, as there is danger of infecting the bladder, 
and thus causing septic poisoning by passing a dirty 
catheter or in neglecting to wash the hands and parts. 
Germs are in this way introduced into the bladder, and 
produce septic poisoning. The catheter should be of 
glass or of silver, and be boiled five minutes before being 
used; then be put in a solution of carbolic acid (i : 20). 

If a gum-elastic or a rubber catheter is to be used, it 
should be soaked in 1 : 1000 corrosive sublimate for half 
an hour, then put it into very hot water until needed. 
Glass catheters are the best; they are easily rendered 
aseptic, and show whether they are or are not perfectly 
clean. Besides the catheter, which is taken to the bed¬ 
side in a basin of very hot water, there are needed a basin 
of corrosive-sublimate solution (1 : 1000), sterilized gauze 
or cotton, a vessel to receive the urine, and a lubricant of 
sterilized oil to render the entrance of the catheter as easy 
as possible. Gynecologists prefer that no lubricant should 
be used, and when one is necessary it should be a mixture 
of carbolic-acid solution (1 140) and glycerin. 

The Operation .—The patient lies on her back with the 
knees drawn up and separated, the upper clothing being 


THE PATIENT. 


69 

divided over each knee to guard against unnecessary 
exposure. The labia are separated with the thumb and 
fore finger of one hand, and the parts washed with the 
corrosive solution. The catheter is inserted into the 
urethra, the opening just above the vagina (PI. 8). If 
there is any difficulty, the catheter should be withdrawn 
a little, and gently pointed a little downward or upward, 
to the right or to the left. If the flow should cease 
before enough urine has been drawn, the catheter is 
withdrawn a little or is inserted a little farther than be¬ 
fore. Before removing the catheter a finger should be 
placed over its end to prevent any drops of urine wetting 
the bed. After the operation the parts are again washed, 
and the catheter boiled and placed in a bottle containing 
a solution of carbolic acid (1 : 20), unless the catheter is 
of rubber; carbolic acid ruins rubber. 

A bladder very full of urine must be emptied grad¬ 
ually. Cystitis is due to many causes, one being the 
introduction of germs into the bladder by means of a 
dirty catheter, and the nurse who passes the catheter is 
always blamed. 

Washing out the Bladder.—To wash out the blad¬ 
der there are needed a fountain syringe, which must 
have boiling water and a disinfectant run through to 
cleanse it, and a glass catheter, which is cleansed in the 
same way as for catheterizing; the parts are also bathed. 
The patient is first catheterized; the catheter is then 
rinsed with boiling water and attached to the rubber 
tubing of the syringe which contains the ordered solu¬ 
tion, its temperature being about ioo° F. The solution 
must run warm before the catheter is inserted. A pint 
of the solution is allowed to run gently into the bladder; 
then the tubing is disconnected from the catheter and the 


7 ° 


PRACTICAL POINTS IN NURSING. 


fluid is drawn off If a double catheter is used, the tub¬ 
ing is not removed. This operation is repeated until the 
fluid returns clear. 

Washing out the Stomach.—A fountain syringe is 
also used in the absence of a stomach-pump to wash out 
the stomach. The hard-rubber nozzle is removed, the 
syringe is cleansed and filled with lukewarm water, the 
tubing is oiled and passed far back in the mouth, and 
the patient is told to swallow. The syringe is raised 
and the fluid poured into the stomach ; when the latter is 
filled there will be retching; the bag is then detached, and 
the tubing placed over a basin or pail, and the contents of 
the stomach removed. This washing is continued until 
the fluid returns clear, after which the tube must be 
removed quickly to avoid retching. Liquid food is gen¬ 
erally given directly afterward. Should there not be a 
fountain syringe at hand, a piece of rubber tubing and a 
small funnel may be used, or the patient may drink large 
quantities of lukewarm water until the water is returned 
clear (lavage). 

4. Administration of Medicines. 

The five ways of introducing medicine into the system 
are by the stomach, the rectum, the cellular tissue (sub¬ 
cutaneously), the skin (inunction), and the lungs (inhala¬ 
tions). 

Rapidity of Absorption of Medicines.—The rapidity 
of absorption depends upon the parts to which the med¬ 
icine is applied, the state of the circulation, the solubility 
of the medicine, and the power it has of passing rapidly 
through a living membrane. Absorption takes place 
more rapidly when the medicine is given subcutaneously, 
it taking only about five minutes for the drug to act, 


THE PATIENT. 




because it enters directly into the circulation; it is more 
slowly absorbed by the vessels of the mucous mem¬ 
brane of the stomach, and slower still by the intestines. 
Absorption through the lungs is rapid on account of 
their large blood-supply. 

It takes about twenty minutes for a drug to act when 
given by the stomach, and about three-quarters of an 
hour when given by the rectum. It is absorbed more 
quickly if given on an empty stomach and if given 
in solution, because it then comes in contact with all 
parts of the mucous membrane of the stomach, and is 
not impeded by the presence of food. Pills and powders 
are absorbed more slowly; they require to be first dis¬ 
solved. There are some medicines—for instance, iron 
and arsenic—which must be given after meals, so as to 
be diluted with the food, to avoid irritating the stomach. 

Action of Medicines.—Sometimes a drug produces 
symptoms or affects the patient in a way entirely differ¬ 
ent from the ordinary: this is called an “ idiosyncrasy,” 
which means an individual peculiarity in regard to the 
action of certain drugs. Some drugs have what is called 
a “cumulative” action; that is, the excretion of the 
drug is so very slow that one dose is not excreted 
from the body when the next one is given ; the drug 
thus accumulates in the body, and after a while symp¬ 
toms of poisoning may develop through cumulative 
action. 

When patients have been taking a drug for some time 
the system becomes accustomed to it, so that after a 
while it takes a larger quantity to produce the desired 
result. This may continue until the habit of taking the 
drug is formed, when the patient not only craves it but 
thinks he cannot do without it. 


72 


PRACTICAL POINTS IN NURSING. 


Some, medicines act as tonics, some as stimulants 
and sedatives—heart and nerve stimulants, heart and 
nerve sedatives ; others as narcotics, hypnotics, astrin¬ 
gents, etc. 

Tonics. —A tonic is a medicine which increases the 
strength and vigor, and gives tone to the whole body. 
There are many kinds of tonics, all of which act upon 
and improve the tone of the organs upon which they 
have a special effect. 

Stimulants are to prevent some depressing effect, as in 
shock, collapse, or in typhoid fever, when the heart’s 
action is depressed. To do good, they should strengthen 
and slow the pulse and respirations, lower the tempera¬ 
ture, moisten the tongue, cool the skin, lessen delirium, 
and induce sleep. An opposite effect would show that 
the stimulants were doing harm instead of good, and 
that they must be stopped and reported. 

Sedatives lessen the force and frequency of the heart’s 
action; they have a soothing influence on the system, 
and lessen pain to a certain extent. 

Cerebral stimulants are drugs that increase the activity 
of the brain. They are also called exhilarants. Cerebral 
sedatives lower the activity of the brain. Vascular stim- 
ula)its are substances that cause dilatation of the periph¬ 
eral vessels, and thus render the flow of blood through 
them more rapid. Vascular sedatives contract the vessels, 
lessening the flow of blood through them. 

Narcotics are at first excitants, and afterward produce 
profound sleep characterized by stupor. 

Precautions to be Observed in Handling’ and Ad¬ 
ministering Medicines. —Medicines must be kept out of 
the reach of patients, especially children and delirious 


THE PATIENT. 


73 


patients; what is left of the medicine when it is discon¬ 
tinued must always be disposed of. The nurse should look 
at the label three times before giving the medicine—before 
measuring it, afterward, and when putting the bottle on 
its shelf; this rule must not be departed from, we hear 
of so many sad mistakes being made. She should also 
be sure that the one who is to have charge of her patient 
while she is absent fully understands how to give the 
medicine. 

Medicine-glasses (Fig. io) and medicine-spoons (Fig. 
12) must be thoroughly washed after 
being used, the nurse having sepa¬ 
rate ones for strong-smelling medi¬ 
cines and for oils. When ordered 
before meals, medicines should be 
given half an hour before , and those 
to be given after meals should be 
given about half an hour after , unless 



Fig. 9.—Medicine-dropper. 




Fig. ii.—D ouble-scale minim- 
glass (natural size). 


otherwise ordered. An unconscious patient must have 
the medicine dropped far back on the tongue, and it will 












































74 


PRACTICAL POINTS IN NURSING. 


be absorbed, if not swallowed. Powders must not be 
given an unconscious patient by the mouth, as with a 
patient in this condition they may cause suffocation. 



Fig. 12.—Medicine-spoons. 


1. Medicines by the Mouth.—The nurse should 
always give minim doses when minims are ordered, and 
drops if drops are ordered, because of the tinctures 
two drops are equal to one minim, but of fluid extracts 
the minims and drops are equal. 

Drops may be given upon a piece of lump sugar or in 
a little water. 


Powders may be given dry upon the tongue and be 
swallowed by drinking water, or may be dissolved in 



Fig. 13.—Wafers or cachets: a, small wafer closed; b, large wafer closed; c, showing 
two sections of the wafer (b); d, cross-section of a wafer filled. 


water or hot milk. Powders that are unpleasant to take, 
such as quinin, are now enclosed in wafers (Fig. 13) or 























THE TAT/ENT. 


75 


in gelatin capsules (Fig. 14). The wafers, which are 
made of rice paper, may be obtained from most chemists, 



Fig. 14.—Empty hard capsules. 


and are from if to if inches in diameter. One is moist¬ 
ened, and the powder is laid in its centre, another wafer is 
laid over the powder, and the two secured together by firm 
pressure. The wafer is then laid on the patient’s tongue, 
and swallowed by drinking water. Or a spoon containing 
the wafer may be filled with water and the mass swallowed. 

Pills should be placed at the back of the tongue and 
be swallowed with water. For children, who find it 
very hard to swallow a pill, the pill may be finely 
crushed and given with a little preserve, molasses, 
honey, or sugar. Powders may also be administered in 
this form. 

Acids, which injure the teeth, should be taken through 
a glass tube and the mouth thoroughly rinsed afterward. 

Oils may be taken in coffee, hot beef-tea, milk, ale, or 
brandy, or in lemon- or orange-juice. Oily medicines 
are sometimes given in gelatin capsules. 

Purgatives must be given early in the day, so that the 
patient will not be disturbed at night, but laxatives should 
be given late in the evening; a result is then had the 
next morning. 

Many medicines of unpleasant flavor are given in 
wafers and capsules. 

Should a patient vomit directly after , or in five or ten 








































































y6 


PRACTICAL POINTS IN NURSING. 


minutes after , taking a medicine by the mouth , or if the 
medicine is returned when given by rectum y it is safe to 
repeat the dose in from fifteen to twenty minutes. 

2. Medicines Administered per Rectum. —Medi¬ 
cines given by the rectum are in the form of supposi¬ 
tories or of enemata, which latter should be given high 
up in the bowel (see p. 59). 

Suppositories. —Suppositories are drugs incorporated 



Fig. 15.—Different forms of suppositories: a. vaginal suppository; b-e rectal sup¬ 
positories ; f, urethral suppository (Thornton). 


with cacao-butter and then made up into conical shapes 
(Fig. 15) for their convenient introduction into the rec¬ 
tum, the vagina, or the urethra. The finger is first oiled ; 
then the suppository is inserted, and pushed well up in 
the rectum until it cannot be felt by the finger, a cloth 
being applied and pressed against the part. The patient 
is in the same position as that for giving an enema. 

3 . Hypodermatic Injection. —A hypodermatic or 

























THE PATIENT. 


11 


subcutaneous injection means the injecting of a medicine 
under the skin for a more rapid and certain effect than 
we would get if given by stomach or the rectum. The 
most convenient places for the injection are the outside 



of the arms, the forearms, the thighs, the chest, and the 
abdomen, the injection being made into the fleshy part, 
avoiding the large blood-vessels, nerves, and bone. The 
syringe (Fig. 16) is cleansed by drawing through it sev¬ 
eral times a I : 20 solution of carbolic acid, followed by 
very hot water. The needle is boiled in a large spoonful 



Fig. 17.—Method of giving a hypodermatic injection. 


of water over a gas-flame. The syringe is loaded with 
the ordered solution, the needle is screwed on tightly, 
making sure that it does not leak at the junction, and 
the air is expelled. 

After cleansing the part a fold of skin is pinched up 
between the thumb and finger (Fig. 17), the needle 
quickly and slantingly inserted, then withdrawn slightly, 
and the fluid is slowly injected. A gentle friction over the 














78 


PRACTICAL POINTS IN NURSING. 


part will distribute the fluid and aid the absorption. The 
needle is quickly removed, and the friction is kept up for 
a few moments. If a large quantity, half a drachm or 
more, is to be injected, it is better to inject deep in the 
muscle, to avoid irritation. 

The syringe must afterward be thoroughly washed, by 
drawing through it the carbolic-acid solution and hot 
water, and the thin wire kept constantly in the needle to 
keep it clear. If not often used, the syringe should be 
soaked every few days in hot water to prevent the pack¬ 
ing from shrinking. Abscesses following hypodermatic 
injections are generally caused by the syringe and needle 
not being thoroughly clean and the solution not fresh or 
pure. If the syringe is in constant use, it should be kept 
in a solution (i : 20) of carbolic acid. Hypodermic syr¬ 
inges hold from 20 to 30 minims. 

Intravenous injection, which is the injection of solutions 
into a vein, is only practised in cases of emergency, as, 
for instance, the injection of blood or of salt-solution 
when there has been an excessive hemorrhage. 

4 . Inunctions.—Inunction is the rubbing of an oil 
or an ointment into the skin for medicinal purposes, as 
in the application of mercury. 

Mercurial Inunction .—When applying mercurial oint¬ 
ment, it must be rubbed on some part where the skin is 
thin, such as the inner sides of the thighs; absorption 
will then take place much quicker. The order of appli¬ 
cation differs somewhat. One way is for the patient to 
take a full bath the first evening, and put on fresh under¬ 
clothing. The second evening a piece of ointment, about 
the size of a small nut, is with the hand rubbed in on the 
inner side of the right thigh. The third evening the left 
thigh is taken, then on successive evenings the left arm- 


THE PATIENT. 


79 


pit and the right are taken. In this way one part is taken 
each evening, and irritation on account of excessive fric¬ 
tion on the same part is avoided. The rubbing should 
take about fifteen minutes, the ointment being thor¬ 
oughly rubbed in. The application is to be omitted on 
the sixth evening, and on the seventh the patient takes 
a warm bath, changes the underclothing, and resumes 
treatment. Dr. W. H. Devine in his lectures on medi¬ 
cines gives the following order: 


First evening, the buttocks ; 
Second “ the thighs ; 


<< 


Third 
Fourth “ 


u 


Fifth 
Sixth 
Seventh “ 


a 


the side of the chest, but not the armpit; 
the internal surface of the arms and 
forearms; 

the back and abdomen ; 
omit treatment; 

bathe, change underclothing, and re¬ 
sume treatment. 


This method of applying mercury to the skin is 
resorted to when the stomach will not bear any mer¬ 
curial, and also to obtain the general action of mercury. 
The mercury passes through the skin without producing 
any irritation, and is absorbed into the general circula¬ 
tion, where the general effects of the drug are produced. 

The symptoms of mercurial poisoning are an increased 
amount of saliva, a fetid breath, swollen and spongy 
gums, with a bluish line along their margins, and a 
metallic taste in the mouth; any one of these symptoms 
must promptly be reported. 

Children are not easily salivated, but when the breath 
becomes fetid the mercury must be stopped at once. 
When applied to children, it is a good plan to put the 


8o 


PRACTICAL POINTS IN NURSING. 


ointment on a piece of flannel and fasten the flannel 
to the part with a bandage. There is then no danger 
of the child getting the ointment over other parts of the 
body. Fresh ointment is put on the flannel every day, 
even if the latter does look soiled. The nurse should 
wash her hands thoroughly after each application, or 
absorption may take place through the skin of the hands. 

5 . Inhalations.—Inhalation is the administration of a 
drug in the form of a vapor, whose action is on the air- 
passages. 

Moist Inhalation .—In the absence of a steam-inhaler 
the vaporized substances may be inhaled from a tea- or a 
coffee-pot standing over an oil or a spirit lamp by the 
bedside, the spout being directed toward the patient; or 
the solution may be put into a pitcher or a tin pan, cov¬ 
ered with paper, which is perforated, and through which 
the patient can inhale the vapor. The patient must breathe 
quite naturally, taking in the vapor through the mouth, 
then closing the mouth, and letting it escape through the 
nose, breathing five or six times in succession before 
withdrawing the face for a few moments; then the pa¬ 
tient begins again, and continues in the same way for 
the length of time ordered. If the patient is not in 
bed, he should inhale the vapor before going to bed; if 
done in the daytime, he should not go out for about an 
hour after. The inhalation of moist air may be obtained 
by means of kettles of boiling water in the room or by 
placing small pieces of unslaked lime in pans of water. 

Dry inhalations may be taken from a heated shovel or 
a plate. The drug is placed on the shovel, and a paper 
cone is made; one end of the cone is put over the drug, 
which is lighted, the vapors being inhaled from the nar¬ 
row end of the cone and taken into the lungs. 


THE PATIENT. 


8 I 


5. General and Local External Applications. 

Baths. — Temperature. — The temperature of baths 
varies, and the water must be tested with a bath-ther¬ 
mometer (Fig. 18). 

A hot bath varies from 98° to 1 io° F. 

A warm “ “ 85 0 to 98° “ 

A tepid “ “ yo° to 85° “ 

A bath must never be given earlier than two hours 
after eating, for the reason that after eating the digestive 
organs, as a rule, are congested, owing to the increased 
activity with which they are obliged to do their 
work in the process of digestion. 

Action of Baths .—A hot bath stimulates 
the nervous system through its action on 
the cutaneous nerves, which are connected, 
in a manner too varied and difficult for us to 
trace out, with the main nerves of the heart 
and with the respiratory and digestive sys¬ 
tems. The nerves being already in a state of 
increased activity, a bath would lead to over- 
stimulation and might lead to shock, fainting, 
vomiting, etc. In simpler words, food increases 
the circulation, and a bath stimulates and ex¬ 
cites the nervous system, hence one might get 
a shock through over-stimulation if a bath 
was given directly after a meal. A patient 
should never be left alone while in the bath¬ 
tub, as faintness may come on, the patient 
may lose consciousness, slip under the water, thermometer 11 ' 
and be drowned. 

Vapor-baths also act as stimulants to the nervous sys¬ 
tem and induce perspiration. A warm bath acts as a seda- 
6 


















82 


PRACTICAL POINTS IN NURSING. 


tive; it relieves inflammation, stupor, and delirium. The 
vessels of the surface of the body are dilated, but not so 
much as by the hot and vapor-baths; the blood is drawn 
from the brain, its activity is lessened, and the patient 
falls asleep. The warm and the hot sitz-bath , also the hot 
foot-bath, increase the circulation in the pelvic organs. 
They relieve retarded menstruation by dilating the ar¬ 
teries, so that the supply of blood is increased in the 
pelvic organs. Mustard, being a powerful stimulant, 
increases the effect of the hot bath. The amount used 
is teaspoonsful to i gallon of water. 

Tepid and cold baths reduce inflammation and fever, 
and act as tonics and sedatives. The first effect of a 
cold bath is chilliness, through contraction of the blood¬ 
vessels ; but later they relax, and the warm blood comes 
to the surface, and if the patient be rubbed, the circulation 
will be increased. To reduce the temperature the patient 
must have the full benefit of the bath. If in bed, each 
part must be bathed separately; each limb must be put 
into the water and well bathed by pouring the water 
over it, using a sponge or a wash-cloth; the other parts 
of the body must be well bathed with a very wet cloth, 
then mopped with towels, and allowed to dry. As 
above stated, cold w r ater contracts the small blood-ves¬ 
sels ; therefore, in sea-bathing or cold baths we apply 
cold water to the head to prevent a rush of blood to the 
brain, because, as the lower limbs are the first to be 
placed in the cold water, the blood-vessels of the legs 
are the first to contract, sending the blood upward. 

It will be found that cold and tepid bathing will relieve 
thirst. When one is thirsty, it is a sign that the system 
is in need of water, though one feels the thirst only in 
the mouth and throat; but if the body is bathed, the 


THE PATIENT. 


83 


skin will absorb the water, and the system will get 
enough water to satisfy its demands. Water when in¬ 
jected will also relieve thirst. After an abdominal ope¬ 
ration, when nothing is given by the mouth for several 
hours, the bathing of the hands and face greatly relieves 
the extreme thirst. Hunger , which is felt in the stomach, 
may also be relieved otherwise than by the mouth. If 
nourishment be given by rectum, it will be absorbed by 
the intestines, and the hunger be alleviated to the same 
extent as though nourishment had been taken by mouth. 

Cold tub-baths are much used in the treatment of fevers. 
The tub is half filled with water at a temperature of 68° 
F. The patient, wrapped in a sheet, is gently lifted and 
gradually lowered into the water. While in the bath 
friction is applied to the limbs and the body, but not 
over the abdomen. Cold is applied to the head, which 
is kept raised. After the bath the patient is lifted out, 
laid in bed on a large rubber sheet covered with a dry 
sheet, and mopped dry. Should the patient complain of 
persistent coldness, heat may be applied. The pulse and 
temperature must be taken before and after the bath. The 
duration of the bath is from ten to twenty minutes. 

Hot Baths .—Hot baths and vapor -baths are given to 
produce perspiration. When the kidneys are not work¬ 
ing properly and the waste material is not carried away 
from the body, hot baths and vapor-baths dilate the super¬ 
ficial blood-vessels (those near the surface of the body), 
causing the patient to perspire profusely and a large 
amount of the waste material to be thus thrown off. If 
a tub-bath is ordered, the tub may partly be filled with 
warm water, the patient be lifted in, and then the tem¬ 
perature gradually increased by adding very hot water. 
At the end of fifteen minutes the patient is taken out, 


8 4 


PRACTICAL POINTS IN NURSING. 


put to bed, and wrapped in blankets, which are tucked 
in very securely about the neck and body so that no air 
can enter. Cold cloths are applied to the head, and 
water is given to drink, because when there is a large 
quantity of water in the body the perspiration becomes 
much more profuse, and consequently the impurities 
thrown off are larger in amount. After the bath is com¬ 
pleted the blankets are removed and the patient is 
sponged with warm water or with alcohol and water. 

Hot Foot-baths .—When giving hot foot-baths the nurse 
must remember to keep the temperature of the water 
even by adding hot water. The bed-clothes at the foot 
of the bed are loosened, newspapers or a rubber cloth 
is spread across to prevent the bed from getting wet, 
the patient’s knees are drawn up, the feet are placed in 
the tub, and the clothing is drawn around the limbs to 
prevent chilling. When taken out the feet are to be 
wiped dry, and care be taken that they are comfortably 
warm by either wrapping them in a blanket or applying 
heaters. 

Hot-air Bath .—To give a hot-air bath, a rubber cloth 
or an oilcloth and blanket are put on the bed (the pa¬ 
tient being turned on one side, as is done in changing 
the bed); the patient’s clothing is removed, and he is 
then wrapped snugly in the blanket, the upper cloth¬ 
ing being supported by means of a cradle. The 
clothing should be well tucked in about the patient’s 
neck and the sides of the bed, under the mattress, to pre¬ 
vent the escape of air, and another oilcloth put over all 
will make the covering much more air-tight. Under the 
clothing, at the foot of the bed, is inserted the spout of 
a kettle of boiling water, which can stand over a gas- 
or an oil-stove or a spirit-lamp placed on a chair or a 


THE PATIENT. 


35 

table, the whole being covered with a blanket to direct 
the steam under the blankets (Fig. 19). If the bed has 



a high footboard, the steam can be directed from one 
side of the foot of the bed. The nurse should guard 
against fire. The doctor will give orders as to the 
length of time the patient is to remain in the bath. He 
may order a thermometer to be placed in the bed, and 
the steam continued until the thermometer registers 120° 
F. or above, when the steam is stopped and the patient is 
treated as after the hot bath. As the water in the kettle 
boils down it must be replaced with boiling water, not 
with hot or cold water, or the steam will stop until the 
water boils again. Careful watch must be kept over the 
patient’s pulse, which can be taken at the temples. 

In the absence of an oil-stove or a spirit-lamp, very 
hot bricks, smoothing-irons, or plates may be wrapped 
in wet flannel or cloths; the hot bricks in contact with 
the wet cloths will make steam. The cloths must be 
placed about the patient on plates or in dishes to prevent 
wetting the bed, and care be taken not to burn the patient. 





































86 


PRACTICAL POINTS IN NURSING. 



If able to sit up, the patient can be seated on a cane-bottom 
chair, the clothing being removed, and surrounded with 
blankets or comfortables, which must be fastened from the 

neck down (Fig. 20). A kettle 
of boiling water over a spirit- 
lamp or an oil-stove, or a pan 
or pail of boiling water, is 
placed under the chair. The 
feet may be put into a pail of 
hot water to increase the effect, 
because the blood-vessels of 
the surface of the body are 
dilated, and remain so while the 
heat or vapor is continued; in 
this way the activity of the skin 
is increased, the pores of the skin 
are opened, and perspiration is 
produced. The nurse should be 
sure that the blankets or coverings are fastened closely 
around the patient’s neck and about the chair to prevent 
the steam escaping. Cold is applied to the head, and 
water is given to drink, for the same reason as that given 
in describing the hot baths, and the after-treatment is the 
same. 

Acid Steam-bath .—An acid steam-bath, which is a 
valuable application in rheumatism, is given by prepar¬ 
ing the patient in the usual manner, and placing around 
her very hot bricks wrapped in flannel which has been 
steeped in vinegar. The bath is continued for fifteen 
minutes, after which the body is wiped over with a towel 
wrung out of cold water, then thoroughly dried. 

Shower-bath .—A shower-bath is given by directing 
the water from an ordinary watering-can, a pitcher, or a 


Fig. 20.—Arrangement of blankets 
in giving a hot-air bath to patient in 
sitting position. (Thornton). 










THE PATIENT. 


*7 


pail elevated a few feet above the patient. To douche the 
head the patient generally lies upon her stomach, her 
head hanging over the side of the bed, or the bath may 
be given her lying in bed. The patient lies on her side 
or back ; the pillows are removed, the clothing loosened 
and pushed well down under the shoulders to prevent 
wetting; a pad is made with rubber cloth, oilcloth, 
or newspapers, by rolling the cloth at each side and 
at one end; the pad is put under the shoulders of the 
patient, her head resting on it, and the unrolled end 
hangs in a pail. The pad will prevent the water from 
running down the patient’s back and the sides of the 
pad, and will also keep the bed dry. The water is poured 
upon the patient’s head from 
a pitcher elevated a little dis¬ 
tance above. After the 
douche the patient’s head 
and shoulders are raised 
and wiped, the pad is slipped 
down into the pail, and the 
clothing and pillows are re- 

Sheet-bath ( Drip-slicet ).— 

The sheet-bath, or drip-sheet, 
which is frequently applied in 
nervous diseases, is generally 
given in the following way: 

The patient, with clothing 
removed, stands in a tub 
which contains enough warm 
water to cover the feet to the 
ankles to prevent chilling (Fig. 21). A sheet wrung out of 
tepid water is thrown over the patient from behind, and 




Fig. 21.—Application of the sheet- 
bath (drip-sheet). 















88 


PRACTICAL POINTS IN NURSING. 


covers the head and entire body. The patient is then 
gently rubbed (over the sheet) with both hands to pro¬ 
duce friction and bring the blood to the surface. As the 
sheet becomes warm it can be re-wet by pouring water 
on it from a cup or a bowl. The doctor will always give 
directions as to the length of time the patient should be 
in the sheet. After being dried some physicians like the 
patient to be put to bed for a certain length of time, while 
others will leave orders for the patient to dress and go 
out for a short walk or to sit by an open window. 

Cold Douche .—The cold douche, or affusion, is given 
by wrapping the patient in a sheet, placing him in the 
bath-tub, and pouring pailsful of water over the body. 
The first pailful should be tepid, and be poured rather 
slowly, to prevent shock. Exhaustion must be watched 
for, and after the affusion the patient should be put to 
bed and wrapped in blankets. Another way, one often 
employed in nervous diseases, is to stand the patient in 
the bath-tub, and direct the water to the spine or to the 
part to be treated by a piece of hose-pipe attached to the 
faucet. 

Cold Pack .—The cold pack is ordered for reducing 
the temperature in many acute diseases. A rubber, an 
oilcloth, or a newspaper is first put on the bed, and 
over this one or two blankets; then a sheet or a table¬ 
cloth which has been dipped in tepid water and wrung 
out is placed on the blankets. The patient is laid upon 
the sheet (the patient’s clothing having first been re¬ 
moved), and every surface of the body is covered by 
pressing the folds of the sheet down between the arms, 
body, and lower extremities. The sheet is tucked well 
in at the neck and feet; the blankets are then folded over 
and tucked evenly under the patient on both sides. The 


THE PATIENT. 


89 


feet are lifted up and the corner ends of the sheets and 
blankets are tucked under them (Figs. 22 and 23). A 
wet towel or compress is applied to the head. The 
patient should be kept in the pack ten or fifteen min¬ 
utes. It will be found that, besides lowering the tem¬ 
perature, the cold pack will relieve nervousness and 
induce sound sleep. 

Hot Pack .—The hot pack is given in the same way as 
the cold pack, with the exception that the blanket, the 
sheets, or tablecloth is wrung out of boiling water by 
placing the blanket in a sheet, and pouring the boiling 
water over them ; two persons, each taking an end of the 
sheet, wring in opposite directions. More coverings are 
placed over the patient than in the cold pack. Should 



Fig. 22.—Application of the cold pack (pressing the sheet between the patient’s arm 

and body). 


the nurse not have anything with which to prevent the 
mattress from getting wet, a table may be arranged with 
blanket and sheets ; in the absence of a table the floor 
near the bed may be prepared. Towels, tablecloths, 













9 o 


PRACTICAL POINTS IN NURSING. 


and old linen may be used where there are but few 
sheets. After the pack the sheets and blankets are 
removed, the patient is wiped dry with soft towels, the 
clothing is put on, heat is applied if necessary, and the 



Fig. 23.—Application of the cold pack (patient completely covered, with wet towel on 

the head). 


pulse and temperature are taken. Partial packs are 
compresses applied to different parts of the body, and 
covered with a flannel or a cotton bandage to prevent 
the patient’s clothing becoming damp. 

Inflammation. —Blood is made up of three parts: a 
watery, almost colorless fluid, called “plasma,” and 
red and white corpuscles, which give to the blood its 
rich red color; there are more red corpuscles in the 
blood than white. The plasma contains a substance 
called “ fibrin,” which is an albuminoid, and which is the 
nourishing part of the blood. Blood in its normal con¬ 
dition is perfectly fluid, but when drawn from the body 
into a basin the fibrin causes the blood to coagulate or 
clot; the corpuscles, which are heavier than the plasma, 
sink to the bottom of the basin and are bound together 
by the fibrin, the whole forming a red semi-solid mass, 
covered with a clear yellowish liquid called “ serum.” 






























THE PATIENT. 


91 


The clot is the corpuscles, together with the fibrin, which 
has now left the plasma, and the scrum is the plasma 
without the fibrin. It is thus seen that when the blood 
is fluid there are two parts—the plasma and corpuscles ; 
when it is clotted or coagulated there are two parts— 
the serum and clot, the clot being made up of the cor¬ 
puscles and fibrin, the serum consisting of the plasma 
without the fibrin. 

Symptoms of Inflammation.—The four symptoms 
of inflammation are heat, redness, swelling, and pain— 
heat , due to the abnormal conditions of the blood in the 
inflamed area; redness , due to increased hematin in the 
blood of the part; swelling, due to increased blood- 
supply; pain, due to pressure on the end-organs of the 
sensory nerves. We can feel heat when the inflam¬ 
mation is on the surface, as in the case of an inflamed 
finger, but where the inflammation is hidden, as in the 
lungs, the brain, or the bowels, or in any of the internal 
organs, we ascertain it by taking the temperature with 
the clinical thermometer. 

Treatment of Inflammation.—If heat or cold is 
applied at the beginning of inflammation, the latter may 
subside; but should it continue, it may terminate in 
an abscess. The poultice or fomentation which is gen¬ 
erally ordered softens and relaxes the skin and tissues, 
dilates the blood-vessels, quickens the circulation in the 
part, so that the fresh, pure blood can pass through, and 
the tight, painful feeling caused by the blood-pressure to 
the part is relieved. Ice contracts the capillaries, and 
thus lessens the amount of blood flowing to the part, and 
pus-formation may be prevented. When pus has formed 
poultices are again ordered to bring it up to the surface, 
bringing it to a head , as it is termed. 


92 


PRACTICAL POINTS IN NURSING. 


Bleeding 1 .— Leeching .—Leeches are used in inflamma¬ 
tion when it is necessary to remove a small quantity of 
blood. The part must be washed very clean, shaved if 
necessary, and be wiped dry; the leech is taken be¬ 
tween the folds of a towel and applied. If it does not 
bite, a drop of blood extracted from a pricked finger 
will generally cause the leech immediately to bite. 
Another very successful way is to put the leech in a 
very small wineglass or cup filled with water, in which it 
should remain for a few minutes; the edge of the wine¬ 
glass is then held to the part we wish the leech to bite, 
and it will come up out of the water and generally take 
hold ; should it move around, it can be guided to the right 
spot. As a leech is always hot and uncomfortable after 
being shut up in a box, it should be put into water (the 
glass or cup having a perforated paper cover) until we 
are ready to use it; being then in its natural element, it 
becomes cool and good-natured. 

After the leech has taken hold a piece of cotton should 
be slipped between it and the skin, because the move¬ 
ments of the leech give a very unpleasant sensation to 
the patient, and tend to make some patients nervous. A 
leech generally holds from i to 2 teaspoonsful of blood, 
and when full it will drop off. If necessary to remove 
leeches after being on a certain length of time, a little 
salt sprinkled on their heads will make them drop off; 
they must not be pulled off, or they may leave their 
teeth in the wound and cause inflammation. The bleed¬ 
ing can further be encouraged by the application of hot 
poultices or fomentations. To stop the bleeding pres¬ 
sure is the best—a pad of graduated compress-cloth ; or 
cold may be used—a small lump of ice. The patient must 
not be left for the night until the bleeding has stopped. 


THE PATIENT 


93 


Leeches should not be applied over an artery, a vein, 
nor over loose cellular tissue where pressure cannot be 
applied, but, if possible, over a bony surface. It should 
also be known that the odor of tobacco, vinegar, or dis¬ 
infectants in the room will often prevent a leech from 
biting. All cavities must be filled with cotton if leeches 
are to be applied near; should a leech get into one, it 
can be removed with an injection of salt and water. 
Leeches must always be disposed of after being used by 
putting them into a very strong solution of salt and water 
or into dry salt, and covering the vessel tightly. The 
nurse must be sure they are dead before throwing them 
away. The American leeches are best for children ; they 
draw less blood. In case the patient is a child, the leech 
should be well covered, so that the child will not be 
frightened. 

Cupping .—Cupping is to relieve pain and congestion, 
and to prevent absorption. Dry cupping draws the 
blood to the surface of, and wet cupping draws blood 
from, the body. 

For dry cupping there will be needed two or three 
tumblers, or wine-glasses, or medicine-glasses ; alcohol; 
a candle, a lamp, or a spirit-lamp; matches; towels. 
The part is washed with warm water, the glasses rinsed 
with hot water, and thoroughly dried. A few drops of 
alcohol are poured into a glass and shaken around; the 
edge of the glass is wet with the finger or is oiled, which 
prevents the fire reaching the patient’s skin; the alcohol 
is then lighted with a match, and the glass turned over 
on the part, which must be an even surface. All this is 
done very quickly. The skin is seen to rise almost im¬ 
mediately in the interior of the glass, and the blood is 
drawn toward the surface. To remove the glass the 


94 


PRACTICAL POINTS IN NURSING. 


skin is pressed down with the thumb or finger. The 
air will then enter the glass, which can be taken off. 
Care must be taken to avoid getting too much alco¬ 
hol in the glass or getting the edges of the glass too 
hot. 

Wet cupping is done with a scarificator. In addition 
to the things needed for the dry cupping, the nurse 
should prepare for the wetting operation some disinfec¬ 
tant and a dry dressing of gauze or compress. The 
part is washed with soap and water and a disinfectant; 
incisions are then made with the scarificator, and a dry 
cup is applied, which draws the blood. After the re¬ 
quired amount has been drawn the cup is removed and 
the dressing is applied. Sometimes poultices are ordered 
to increase the effect. The nurse must have everything 
prepared for the physician, and stand ready to hand what¬ 
ever he needs. 

Fomentations.— Moist heat is applied to the body in 
the form of warm or hot baths, poultices, and fomenta¬ 
tions (stupes). For a hot-water fomentation coarse flan¬ 
nel or two or three thicknesses of old blanket is the 
best. White flannel is preferable, as the dyes of colored 
flannels are apt to be poisonous. The flannel is placed 
in the middle of a towel, and both dipped in a basin of 
boiling water for a fev moments, the ends of the towel 
being twisted in opposite directions until all the water is 
wrung out; the fomentation is then carried to the bedside, 
the towel untwisted, and the flannel shaken out, before 
applying, to let in the air; it will then retain the heat 
much longer. The fomentation is covered with dry flan¬ 
nel or towels and a piece of rubber cloth (both flannel 
and rubber being larger than the fomentation), and a 
bandage is applied to keep it in position. This proce- 


THE PATIENT. 


95 


dure will retain the heat of the fomentation longer and 
also keep the patient dry. When renewing the fomenta¬ 
tion the fresh stupe must always be ready before the 
cool one is removed. 

Laudanum and turpentine stupes are prepared in the 
same way as the preceding: when the flannel has been 
wrung out of the water, from 15 to 20 drops of laudanum 
are sprinkled over it. For the turpentine stupe about 
30 drops of turpentine are sprinkled over the flannel, or 
to I pint of boiling water there are added 3 teaspoonsful 
of turpentine; this solution is well mixed and the flannel 
put in, stirring all the time. The flannel is then taken 
out, wrung, and applied, the turpentine being then more 
evenly distributed over the flannel. 

Mustard fomentation consists of flannel wrung out 
of very hot water (not boiling), about 1 pint, to which 
has been added 1 tablespoonful of mustard. It is pref¬ 
erable to make a paste of the mustard before adding it 
to the hot water; there will thus be less danger of it 
forming lumps. Mustard must not be added to boiling 
water, or the action of the volatile oil which the mus¬ 
tard contains, and to which it owes its value, will be de¬ 
stroyed. 

Fomentations to the eyes and neck are changed every 
few minutes. Flannel, old cotton handkerchiefs, or 
sponges may be used, all of which can be put in boiling 
water and be pressed out with a lemon-squeezer, which 
is veiy handy for these small stupes. 

When stupes are discontinued the part must be dried 
and covered with absorbent cotton, flannel, or a towel 
for a while, and afterward be bathed with alcohol, which 
will be a preventive against cold. 

Poultices.—A flaxseed-meal poultice is made by rap- 


9 6 


PRACTICAL POINTS IN NURSING. 


idly stirring the meal little by little into boiling water. 
When the mixture is of the consistency of mush, stiff 
enough to drop away from the spoon, it is well beaten 
with the spoon to remove the lumps. This flaxseed 
paste is spread smoothly and evenly half an inch thick 
on a piece of old cotton, cheese-cloth, mosquito-netting, 
or even on paper, of the desired size, leaving a margin 
to turn in of about i^- inches all around the poultice. 
Another layer of muslin is put over the face of the poul¬ 
tice; the edges are turned well under to prevent the flax¬ 
seed escaping. The poultice should be rolled in a towel 
and carried on a plate to the patient. When applying 
the poultice the nurse places her hand under it, the back 
of her hand resting on the part to which the poultice is 
to be applied, and slowly removes her hand; this will 
get the patient used to the heat, and is far better than 
suddenly putting a hot poultice on an already tender 
and sensitive skin, as repeated applications make the 
part very tender. This fact applies also to children : 
if once a child is frightened by too hot a poultice, the 
nurse will probably never be able to put on another. 
The poultice should be covered with flannel and rub¬ 
ber cloth or with newspapers, and be fastened with a 
bandage; the heat will thus be retained and the patient 
kept dry. 

Large poultices should be changed every four hours, 
or if well covered they will last five or six hours; the 
smaller ones must be changed every one or two hours. 
A poultice must never be removed until a fresh one is 
made and ready to be applied; then the old poultice is 
removed and the part wiped dry with a piece of soft cot¬ 
ton, for the reason that the air acts as an irritant to a 
moist surface and causes an itching sensation. A poul- 


THE PATIENT. 


97 


tice once used must never be reheated: it is valueless: 
hence poultices must be freshly made each time they 
are needed. If, for some reason, the nurse has to wait 
before applying a poultice, it can be kept hot by placing 
it between two plates over a pan of boiling water; if it 
is put in an oven, it will bake. 

When applied for the removal of a slough, the poul¬ 
tices must be discontinued as soon as the slough is re¬ 
moved, as further poulticing will prevent the healing of 
the part by making the skin too moist and flabby. 

Jacket-poultices .—A jacket-poultice, which is a poultice 
to encircle the whole chest, is readily made by taking 
four large pieces of muslin, old linen, etc., that will reach 
from the neck to the waist-line, and sloped out to fit 
under the arms; the poultice is then made in the usual 
way, one poultice being applied to the back and one to 
the chest, and fastened together over the shoulders and 
down the sides with safety-pins to keep them in posi¬ 
tion ; then the usual coverings and bandages are applied. 
The jacket-poultice must not be renewed until the fresh 
poultice is ready to be applied; then the bandage is 
unpinned, the patient turned on his side, the cold 
poultice removed, the back wiped dry, and the fresh 
poultice and coverings applied; then the patient is 
turned on his back and the fresh poultice applied to the 
chest and fastened with safety-pins. It is an expert act 
to remove a poultice or a fomentation without awaken¬ 
ing a sleeping patient: it can be done on almost any 
part of the body excepting the back, and even here it 
may be accomplished if the nurse has the confidence of 
her patient, who will wake up just enough to turn over 
and have the poultice renewed, and then drop off to 
sleep again. 

7 


9 8 


PRACTICAL POINTS IN NURSING. 


A bran-jackct is made by placing bran between two 
pieces of muslin, which are cut the same as for the 
jacket-poultice, and stitching them all round and in dif¬ 
ferent places after the manner of quilting, to keep the 
bran in place. The bran-jacket may be applied dry after 
heating it in an oven, or it may be placed in boiling 
water for a few minutes, then wrung out, laid on the 
part, and covered with rubber cloth or flannel and fast¬ 
ened with a bandage. When cold it is again wrung out 
of boiling water and reapplied. There should be two 
jackets made. 

Bread Poultice .—Bread poultices are applied to very 
tender parts, and are milder than flaxseed, but they do 
not retain the heat as long. The poultice is made by 
stirring stale bread-crumbs into boiling water, and beat¬ 
ing the mixture well to remove the lumps ; then the 
water is drained off and fresh boiling water is added, 
which will remove the alum found in some bread; the 
second water is drained off, the poultice being then 
spread and applied. 

Mustard Poidtice .—A mustard poultice is made by 
adding to very hot water two parts of mustard (all 
the lumps being thoroughly dissolved) to four parts 
of flaxseed meal, and the poultice is spread and ap¬ 
plied in the usual way. If the mustard be sprinkled 
over the flaxseed poultice, there is danger of burning 
the patient in patches; we avoid this by first dissolving 
the mustard in the water. 

Charcoal Poidtice .—A charcoal poultice, which is a 
very dirty poultice to prepare, is generally made with 
one part of charcoal and two parts of flaxseed meal, 
mixed and made in the usual way, a little additional 
charcoal being sprinkled over the surface of the poul- 


THE PATIENT. 


99 


tice before applying. This poultice, which is ordered 
for wounds which have an offensive discharge, acts as 
a deodorant by absorbing the odor and promoting a 
healthy condition. Another method of making this 
poultice is to add \ an ounce of charcoal to 4 ounces 
of flaxseed meal and bread-crumbs, mixing all together 
and making the application in the ordinary way. 

Starch Poultice .—A starch poultice is made by taking 
ordinary laundry starch, mixing it with cold water, and 
then adding boiling water to make it into a thick paste. 
A starch poultice is used in skin diseases to relieve irri¬ 
tation. Very often belladonna or laudanum is sprinkled 
over the surface of both starch and flaxseed poultices to 
act on the nerves of the part and allay the pain. The 
effects of the drug must be watched for; this is very im¬ 
portant, especially in the case of children. 

Spice Poultice .—A spice poultice is made by placing 
in a bag equal parts of cloves, cayenne pepper, ginger, 
and cinnamon. The bag is sewed up and submerged in 
hot alcohol or in vinegar for a few moments, when it is 
wrung out and applied. Another way is to mix the 
spices with about 1 ounce of flour and enough hot alco¬ 
hol to make a paste, and to spread this between two 
layers of muslin or linen. If the skin is tender, the 
proportions of cloves and pepper should be decreased. 
In the absence of the spices flannel may be wrung out 
of hot whisky or pure alcohol and applied to the part. 
The action of a spice poultice is that of a mild counter- 
irritant. 

Yeast Poultice .—To make a yeast poultice, which is 
used as a stimulant to slow-healing wounds, take 3 
ounces of fluid yeast and hot water, and stir in a quarter 
of a pound of either flour, oatmeal, flaxseed, or Indian 


IOO 


PRACTICAL POINTS IN NURSING. 


meal. This mixture is heated, stirring it all the time 
until it is hot; or it is set by the fire until it rises; 
it is then spread on muslin the same as a flaxseed- 
meal poultice is prepared, and is applied while fer¬ 
menting. 

Slippcry-clm Poultice. —A slippery-elm poultice is made 
by mixing slippery elm with very hot water; they should 
be mixed slowly or the poultice will become lumpy, and 
be well beaten before spreading it on the linen. 

Hop Poultice. —A hop poultice may be made in the 
same manner as a bread poultice, or by filling a bag 
about half full with hops and wringing it out of boil¬ 
ing water when needed. 

Antiseptic Poultices .— Corrosive sublimate is used for 
antiseptic poultices, the strength varying from i : 5000 to 
1 : 10,000. A towel, absorbent cotton, or gauze is wrung 
out of a hot solution, applied to the part, and covered 
with a dry towel, oil-silk, or paper, and a bandage. Car¬ 
bolic acid is used for poultices in strengths varying from 
1 :60 to 1 : 100. Both carbolic acid and corrosive sub¬ 
limate are very easily absorbed, and the general effects 
of the drugs must be watched for. Crcolin, which is 
not so poisonous as the preceding, is used in strengths 
of from 2 to 5 per cent. For boric-acid poultices a 4 
per cent, solution is generally used. 

Green-soap Poultice. —A green-soap poultice is a thin 
layer of green soap spread over a pad of gauze, ab¬ 
sorbent cotton, or a towel, and covered with a dry towel 
and a bandage. 

Ice Poidtice. —An ice poultice is to relieve hemor¬ 
rhage, or pain due to neuralgia or inflammation, and 
is made of crushed ice, mixed with salt and sawdust, 
flaxseed, bran, or oatmeal, and sewed up tightly in 


THE PATIENT. 


IOI 


rubber cloth, a coarse towel, or in paper, so as not 
to wet the patient and the bed. 

It is not at all difficult to apply poultices or fomenta¬ 
tions in a railway car: all one needs is a pint tin-cup, 
flaxseed meal, a spoon, paper, and a spirit lamp. In 
cases of sudden illness of an adult or a child attacked 
with croup, where fomentations will give great relief, 
hot water can generally be had, and handkerchiefs be 
wrung out of it and applied. 

Dry Heat.—Dry heat is applied with hot bottles, 
bricks, plates, or smoothing-irons, well covered to pre¬ 
vent burning the patient. Hot flannel and bags filled 
with salt or bran or sand are used in aural surgery to 
relieve pain in the ear: the bags are made of old mus¬ 
lin or gauze, cut half-moon shape, and applied around 
the ear, never over it, as there would be danger of the 
heat causing the walls of the aural canal to swell; this 
would bring the walls together, and if the Eustachian 
tube were closed and there was an abscess in the mid¬ 
dle ear, the nurse would have a sad state of affairs. 
Two bags will be needed—one being in the oven or 
in a farina-boiler heating, the other being on the pa¬ 
tient. When using a hot-water bag the contained air 
must be expelled before putting in the stopper; the 
bag will then lie flat. 

Application of Cold .—Lcitcr Coil .—Cold is applied 
to a part to relieve pain, to relieve inflammation, to ar¬ 
rest hemorrhage, and as a local anesthetic to freeze 
the tissues and allow slight operations to be performed 
painlessly; also as a stimulant, as when cold water is 
dashed on the face of a fainting person. It relieves 
pain by reducing the feeling of sensation, acting as an 
anesthetic; it relieves inflammation by contracting the 


102 


PRACTICAL POINTS IN NURSING. 


blood-vessels, so that the amount of blood flowing to 
the inflamed part is considerably lessened and pus- 
formation is prevented. 

The Leiter coil (Figs. 24, 25), which is used to apply 

continued cold to a part, is made 
of coils of pliable metal through 
which ice-water runs continually. 
Coils are made to fit the head, 
the ear, the abdomen, and differ¬ 
ent parts of the body. Two long 
pieces of rubber tubing are at¬ 
tached to the coil; the end of 
one tube being put in a vessel 
containing ice-water; the water 
fig. 24.—Leiter coil applied to runs to the coil, and after cir- 

tlic ear 

culating through it the water 
passes out of the second tube into a pail on the floor 
to receive it (Fig. 25). The ice-water pail, which should 
be a few feet above the patient’s head, may stand on a 

hassock or a small chair placed on a table, or it may 

hang from the knob of one of the bedposts; the reser¬ 
voir must not be too high or the water will run through 
the coil too rapidly. If the tubing is large, the second 
tube which conveys the water to the pail may be made 
smaller by tying it a little tightly at different parts 
along its length, thus preventing the water running out 
too rapidly. The supply-pail must be kept filled with 
water and ice. Should there be any difficulty in get¬ 
ting the water to run, or should the water stop run¬ 
ning, by putting the end of the lower tube in the mouth 
and making slight suction the water will generally begin 
to circulate. These coils are fastened to the part by 
tapes passed through slits at each end and tied around 






THE PATIENT 


103 


the part. Should the patient complain of the intense 
cold, a piece of compress first put between the part and 
the coil will make it more bearable ; this applies also to 
ice-bags. 

Ice-bags. —Ice-bags must carefully be watched : if the 
nurse has only one ice-bag, ice-cold compresses must be 

applied to the part while the 
bag is being refilled. Ice 
melts rapidly, and if the bag 
remains on after the ice has 
melted, the water will rise to 
the temperature of the part 
to which it is applied and do 



Fig. 25.—Leiter coil applied to the head. 


much harm. When applying an ice-bag to the back or 
to any part of the body that will lie upon the bag, two 
things must be remembered: first, that there is air in the 
bag, and second, that the heat of the part to which it is 
applied very rapidly melts the ice in the upper portion of 
the bae, the water becomes warm, and the ice lying at 











































































104 PRACTICAL POINTS IN NURSING. 

the bottom of the bag does no good. To remove the 
water and air, one end of a piece of small rubber tube 
is placed in the mouth of the bag, the other end in a pail 
on the floor. In this way the water will be drained off as 
the ice melts, and continuous cold will be applied. 

To fill an ice-bag the ice is wrapped in a coarse cloth 
or a towel and crushed with a hammer, or the ice may 
be broken into small pieces with a strong pin or a darn¬ 
ing needle. Fill the bag half full, and press out the air 
before sealing it. 

When cold is applied to the head and spine or to 
the head alone, heat is generally applied to the feet 
and other parts of the body to avoid any depressing 
effect on the circulation. 

Counter-irritants.—Counter-irritation relieves a deep- 
seated inflammation by irritating the ends of the sensory 
nerves and dilating the blood-vessels of the part so that 
the circulation of the blood through them is increased; 
the blood is brought to the surface, thus relieving the 
inflamed part Jbeneath. There are three classes of 
counter-irritants. Counter-irritants of the first class 
are rubefacients , which redden the skin by distending 
the small blood-vessels. Friction will also do this, as 
it tends to send the blood out of the small blood-vessels 
through the veins ; the circulation of the part is increased 
and the swelling is removed; other counter-irritants of 
this class are mustard poultices and turpentine and 
mustard fomentations (stupes). 

Counter-irritants of the second class act more strongly: 
they, too, are rubefacients, but of a stronger kind; for 
example, a mustard plaster, which is stronger than a 
mustard poultice. The blood-vessels are dilated, the 
circulation is greatly increased, and a certain amount of 


THE PATIENT. 105 

the blood is brought to the surface; the blood in the 
inflamed part is lessened and the pain is relieved. 

A counter-irritant of the third class is vesication , or 
blistering, which produces true inflammation by drawing 
the blood from the inflamed part directly to the surface, 
and there is an outpouring of the serum (the water of 
the blood) between the cuticle and the true skin. 

Counter-irritants are generally applied a little distance 
from the inflamed parts, for the reason that if the vessels 
of these parts are dilated more blood is brought to them. 
For instance, in cases of meningitis, severe headaches, 
and other affections of the head a blister is sometimes 
applied to the nape of the neck: the blood-vessels here 
being dilated, more blood is brought to them, and the head 
is relieved. It is the same when a hot-water or a mustard 
foot-bath is given to relieve headache: it causes greater 
dilatation of the blood-vessels in the limbs, so that more 
blood is drawn to them, thus relieving the head. If the 
blister was applied directly over or too near the inflamed 
part, there would be danger of the accumulation of blood, 
or the “ congestion,” increasing and doing more harm 
than good. 

The reader may have had an inflamed finger, and have 
noticed that when the hand was hanging down by the 
side the throbbing and pain were increased ; this was due 
to the blood rushing down to the hand, thus putting 
more pressure upon the finger; but on raising the 
hand the pain was relieved, because the pressure of blood 
became less. It is for this reason that rest is ordered 
for inflammation. The part is kept quiet and elevated ; 
the arterial blood is thus prevented from rushing to the 
part, and the venous blood can better return to the 
heart. 


io6 


PRACTICAL POINTS IN NURSING. 


Mustard Plaster .—A mustard plaster is made of mus¬ 
tard and flour, equal parts, or of all mustard, mixed into 
a paste with warm water and spread between two layers 
of muslin or soft linen rag. When mixed with flour 
the action of the mustard is slower and it is not so liable 
to blister. The plaster is covered and left on from ten 
to twenty minutes. When it is removed a little vaselin 
is rubbed over the part, which is covered with a soft 
cloth. While the plaster remains on the patient a corner 
should be raised from time to time, to see that it is not 
blistering ; especially is this necessary with unconscious 
and paralyzed patients. For children four parts of flour 
are mixed with one part of mustard ; when the skin is 
red the plaster is removed and a flaxseed-meal poultice 
applied. The action is slower, but blistering is prevented. 
White of egg and mustard make also a non-blistering 
plaster. 

Tincture of Iodin .—Tincture of iodin is a counter- 
irritant ; it is painted over the part with a swab or a 
camel’s hair brush, a little of the tincture being poured 
into a cup or a saucer. Two coatings will be sufficient. 
The iodin stains the skin a dark yellowish-brown color, 
and may cause a painful, smarting sensation, which can 
be relieved with alcohol or ammonia, though some pa¬ 
tients prefer olive oil. The swab or brush must never 
be put into the bottle after being used on the patient. 
There should be a separate brush for each patient. 

Croton Oil .—Croton oil is a powerful counter-irritant; 
3 or 4 drops are sprinkled on a small piece of flannel 
and rubbed into the skin ; this gives rise to a vesicular 
eruption. 

Blisters.— Cantharidism .—A blister is raised with either 
cantharidal plaster (Spanish-fly), cantharidal cerate (blis- 


THE PATIENT. 


107 


tering cerate), or cantharidal collodion. The part must 
be washed, and shaved if necessary, and be wiped per¬ 
fectly dry; the plaster is cut the desired size and shape 
(Fig. 26) and applied. If the cerate is used, it should be 




Fig. 26.—Shapes of plasters: a, for left ear; b, for right ear; c, for chest; d, 
for shoulder; e, for back; f, for side; g, pattern for breast-plate; h, plaster for 
breast. 


spread on a piece of cotton and be kept in place with a 
bandage. If adhesive plaster is used to keep either of 
these plasters in place, there will be no room for the 
blister to rise, and it will cause a dragging pain. Before 
applying the cantharidal collodion the parts to be blis¬ 
tered must be outlined with vaselin or with oil, which will 
prevent spreading of the blistering solution. The collo¬ 
dion, which is painted on with a swab or a brush, causes 
an itching sensation when first applied; patients must be 
told of this to guard against scratching. 

The action of the cantharis must be watched for. It 
is a powerful irritant and affects the kidneys, and some¬ 
times causes painful urination or suppression of urine. 









io8 


PRACTICAL POINTS IN NURSING . 


For children and very weak persons the plaster should 
be kept on just long enough to start the blister, then a 
poultice be applied to make the blister rise, otherwise a 
slough may be formed. It generally takes from four to 
eight hours for a blister to rise (collodion acts more 
quickly). If at the end of that time the blister has not 
risen, the application of a flaxseed poultice will hasten 
this result. 

Should the physician leave to the nurse the time of 
applying the irritant, she should apply it during the early 
part of the day, so that the blister will rise before even¬ 
ing. If applied in the evening, the patient is kept awake 
through the night with the pain caused by the rising of 
the blister. When the blister has risen, the lower part 
should be snipped with a pair of scissors, and the fluid 
discharged on a towel or a piece of cotton to prevent 
irritation of the skin, and then be dressed with vaselin. 
It must be remembered that the cuticle, or skin, of the 
blister must not be removed without orders; the skin is 
only removed when the blister is to be kept open. In this 
case it is called a “perpetual” blister, and is dressed with 
some irritating ointment. If the physician wishes the 
fluid to be reabsorbed, care must be taken that the 
skin is not broken. 

Chloroform Blistering .—A ready way to produce a 
blister is to pour a few drops of chloroform or of strong 
ammonia into a watch-crystal, which is then placed over 
the part; the blister will rapidly rise. 

A blister must not be produced over a bony part, be¬ 
cause here the circulation is less active, and a slough 
may be the result. 

Massage.—Massage consists of a series of movements 
which give to the muscles and the whole system strength 


THE PATIENT 


IO9 


and vigor, and in a certain sense takes the place of active 
exercise, but it is entirely different from rubbing. The 
work is done by the ball of the thumb, the fingers, and 
the palm of the hand. Some of the movements are 
stroking with the finger-tips, followed by deep stroking; 
kneading, which is grasping a muscle or group of mus¬ 
cles between both hands or between the thumb and fin¬ 
ger, and pressing, rolling, and squeezing it, beginning at 
the extremity of a limb and working upward. Then 
there is the deeper kneading, as in treating an arm or 
limb, followed by rolling or fulling, which is a to-and- 
fro movement with the limb between the palms of the 
hands, the limb being rolled back and forth; deep pres¬ 
sure with the knuckles, used when a part is either hard 
or flabby and we want to reach a deep-seated nerve; 
twisting of the muscles, followed by vibration, which 
stimulates the capillary circulation ; percussion , which is 
striking or beating the surface with the palm of the hand 
(clapping) or the side of the hand with the fingers held 
very loosely (whipping), and with the fingers held stiffly, 
which is true percussion. All this is followed with light 
friction. On the abdomen the kneading is begun at the 
ascending colon, then is continued on the transverse and 
descending colon. The tissues are rolled, not rubbed; 
a firm grasp of the muscles should be taken, and a con¬ 
siderable amount of force be used, but not too much. 

Repose of touch should be cultivated, and work be 
done from the wrists, or the movements will be jerky 
instead of being even. Tender parts should be gone 
lightly over at first: later on more force may be used. 
It will be found, if done skilfully (and skill can only 
be acquired by constant practice), that massage is a 
nerve sedative, relieves neuralgia and also some chronic 


110 


PRACTICAL POINTS IN NURSING. 


affections. In order that the student may have a perfect 
knowledge of massage and its application, it is absolutely 
necessary that she should first take a complete course in 
anatomy, and familiarize herself with the bones, muscles, 
and organs of the body, their form and location. 

Liniments.—Liniments are for external use, to relieve 
pain or to produce local stimulation. They must be 
applied to the skin with friction until the part is en¬ 
tirely dry. A cloth must not be used, or the effect will 
not be so good. 

Lotions.—A lotion is a medicinal application, and may 
be evaporating or non-evaporating; it is used externally 
for cooling purposes and for the relief of pain. Where 
evaporating lotions, such as alcohol, vinegar, or camphor, 
are used, one single thickness of cotton, saturated with 
the selected lotion, is applied and left uncovered. Lotions 
must be changed often, and not be allowed to become 
warm or dry. Non-evaporating lotions are applied with 
two or three thicknesses of compress wrung out of the 
ordered solution and covered with rubber tissue or cloth, 
and a bandage to keep it in position. 

Gargles, Sprays, etc.—To gargle the throat the solu¬ 
tion is taken into the mouth, the head being thrown back 
and moved from side to side. The fluid in this way is 
brought in contact with the back part and sides of the 
throat, and is more beneficial than by causing the fluid to 
bubble up in the throat. If the gargle is an acid, the 
mouth must afterward be rinsed with water, so that the 
teeth will not be injured. Sprays are much better than 
gargles when the throat is ulcerated ; a patient can seldom 
gargle thoroughly. A spray will reach all the parts. 
When spraying or painting the throat the nurse should 
stand a little to one side, so that the patient will not 


THE FAT/ENT. 


I I I 


cough in her face. When painting, the rule is to paint 
from down np y because the patient will always gag; by 
beginning to paint at the bottom of the throat one can 
paint upward, bringing with one sweep the brush or 
cotton-stick out of the mouth. A roll of paper answers 
nicely for blowing powder into the throat; the paper roll 
is placed back in the throat with the powder inside, and 
is blown in by the nurse or is inspired by the patient. 

All instruments used in the throat must be very clean 
and warm, also be free from odor, so as not to nauseate 
the patient. The back part of the throat is connected 
with the Eustachian tube, which is about inches long, 
and passes from the ear to the back of the throat, and 
which in order to hear perfectly should be kept open; 
but when one has a cold in the throat the mucous mem¬ 
brane which lines the back of the throat and this little 
tube is swollen, and a temporary deafness results. 
Gargling the throat with very hot water is very bene¬ 
ficial when the soreness is first felt, and will very often 
prevent its extension. The nose also calls for special 
attention; its passages must be kept open and clean. 
We breathe through the nose, and by so doing the cold 
air becomes warmed in passing through the nasal cavities 
to the lungs, and dry air is moistened; but if we breathe 
through the mouth, as when the nostrils are inflamed, 
the cold air goes directly to the lungs, the mouth and 
throat become dry, and the throat becomes sore. Certain 
diseases of the nose call for special treatment and special 
directions. When spraying the nose it should be sprayed 
down on a level with the roof of the mouth, and not up 
to the roof of the nose; this mistake is often made. 
The patient must be instructed to close the mouth and 
draw the fluid into the throat, then to cough it out; if 


I 12 


PRACTICAL POINTS IN NURSING. 


this is not done, the fluid will run out the nose as the 
spray is applied. 

Eye-drops.—To put a drop in the eye the patient 
should look up, the lower lid be drawn down, and the 
drop be put in with a dropper or a quill on the centre of 
the lower lid; it will then flow over the surface of the 
eye to the duct next the nose. A mistake often made is 
that of putting drops in the eye in the inner corner, next 
the nose. 

The interior of the eyelids and front of the eyeball are 
covered with a mucous membrane called the “ con¬ 
junctiva,” and in the orbit on the outer side of the eye¬ 
ball is a gland called the “ lachrymal gland,” which 
secretes the tears and keeps the eye moist. The tears 
pass over the surface of the eyeball, and those not used 
are carried off into the nose by a small canal called the 
“ lachrymal duct,” which passes down from the orbit into 
the nose. This secretion of tears is going on day and night, 
but we do not notice it until either the conjunctiva is irri¬ 
tated by a foreign body in the eye or by strong vapors, or 
when we are affected by strong emotional feelings of sor¬ 
row or of happiness, when the secretion of tears by the 
lachrymal gland exceeds the drainage-power of the duct 
and they overflow on the face. When we try not to cry 
the tears pass down through the duct to the nose, and 
pass out through the nose; then we get the “ blowing of 
the nose,” commonly thus called when people try not to 
cry. So we see that the gland which secretes the tears 
is at the outer part of the eye, and the duct which re¬ 
moves them from the eye is in the inner corner. It 
must now be clear why a drop should be put in the cen¬ 
tre of the lower lid, so that the solution will pass over 
the surface of the eye to the duct next the nose. 


THE PATIENT. 


"3 


Ointment should also be applied in the centre of the 
lower lid, either with a small spatula used for the pur¬ 
pose, with the handle of a small teaspoon, or with any¬ 
thing that has a smooth, flat, narrow surface. 

A medicine-dropper may be used to syringe the eye , 
which must be done from the inner to the outer corner. 

Syringing the ear must not be done with too much 
force or the drum-membrane may be ruptured. A foun¬ 
tain syringe (Fig. 27) is the 
best to use, as with it we get 
a continuous flow, and injec¬ 
tion of air into the ear is 
prevented; still, an ordinary 
Davidson syringe will answer 
if the nurse has not a fountain 

Fig. 27.—Fountain syringe. 

or a hard-rubber syringe. 

The necessary things for syringing the ear are a foun¬ 
tain or a hard-rubber syringe, a bowl for the water to be 
used (unless the nurse uses a fountain syringe), a bowl for 
the return flow, a towel for the patient’s shoulders, and 
one for the assistant. The syringe is filled, the air ex¬ 
pelled, and the tip of the ear is pulled backward and 
upward to straighten the canal, which is then syringed 
gently. The patient may hold the small bowl beneath 
the ear, but if not able an assistant will be necessary. 
Warm water is used for ordinary syringing. 

For an ear-douche to relieve inflammation the tempera¬ 
ture of the water is about ioo° F. The douche is continued 
for fifteen or twenty minutes, unless the patient should 
complain of dizziness, which is often due to the water 
being directed to one spot or to too much force being 
used. When syringing for the removal of discharge, the 
nozzle of the syringe should be moved around, directing 
8 













I 14 PRACTICAL POINTS IN NURSING. 

the stream against the sides of the auditory canal and 
not in the central axis. This procedure is also necessary 
when syringing to remove a hard collection of wax. By 
syringing thus the water will pass between the sides of 
the canal and the plug of wax, and, reaching the space 
behind, will bring out the wax with the return current. 

Many persons syringe their own ears, which operation 
is easily done if one has a fountain syringe. The head 
is held over a bowl; one hand is passed over the back 
of the head to hold the auricle and straighten out the 
canal, while the other hand directs the stream of water 
into the ear. 

* 

An ear-batli , which may be of plain water or of water 
to which is added a small quantity of sodium bicarbonate 
is used to soften an accumulation of wax that cannot be 
removed by syringing. The head is laid on the unaf¬ 
fected side, the tip of the ear is pulled slightly backward 
and upward to straighten the auditory canal, and the 
ordered solution is poured into, and remains in, the ear 
about fifteen minutes, when the mass will be softened 
sufficiently to be removed by syringing. A piece of 
cotton should be worn in the ear for a while after the 
operation to prevent chilling. 

No liquids should be dropped into the ear without 
direct orders from a specialist. Laudanum, oil, glycerin, 
lard, and other applications that we hear of as ear-drops 
are all injurious, though they may alleviate the pain for 
the instant. Pain should be relieved by heat until an 
aural specialist can be consulted. The nurse is justified 
in putting oil into the ear only when it is invaded by an 
insect; then the oil must be warmed and poured in, and 
the insect will float to the top and fall out. If no oil is 
at hand, warm water will do—the insect will thus be 


THE PATIENT. 


US 

drowned. Beans and other things likely to swell with 
water must not be interfered with, but a surgeon should 
at once be consulted. The ears must not be picked with 
pins; the drum-membrane is often perforated through 
this habit. Before washing the patient’s head it is always 
well to put cotton in the ears, the ends of the pledgets 
having first been dipped in oil or in vaselin. If cotton 
alone is used, the water will soak through; but as water 
and oil do not mix, the water cannot get beyond the oil 
into the ears. 

II. NURSING IN OBSTETRIC CASES. 

Pregnancy: Signs and Symptoms.—The probable 
signs of pregnancy are—stoppage of menstruation, morn¬ 
ing sickness (though with some women this is entirely 
absent or may come on regularly every evening), en¬ 
largement of the abdomen at the end of the third month, 
a sense of weight and fulness in the breasts, and darken¬ 
ing of the skin around the nipples. Still, these symp¬ 
toms are uncertain. Nurses having experience in gyne¬ 
cologic wards know that the abdomen may be en¬ 
larged by a tumor, and that the blue color of the vagina, 
due to dilatation of the veins from congestion of the cir¬ 
culation, may be caused also by the presence of a tumor. 
Menstruation may cease from cold and from anemia; or 
a change of climate and of living will many times stop 
the menstrual flow for a few months, as will also an 
attack of any of the acute fevers, until the nervous sys¬ 
tem .regains its normal condition. In some womb dis¬ 
eases the breasts have increased in size and contained 
milk, and the nausea and vomiting may be caused by 
some disease of the stomach. None of these symptoms, 
taken singly, is a positive sign of pregnancy. 


lib PRACTICAL POINTS IN NURSING. 

The positive signs of pregnancy are the fetal pulse, 
which can be heard about the sixth month, and the fetal 
movements, which are felt between the fourth and fifth 
months. There are other signs, but they belong to the 
obstetrician. 

Duration of Pregnancy.—The average length of 
pregnancy is two hundred and eighty days—nine cal¬ 
endar months, or ten lunar months. 

Conception and Date of Confinement.—Conception 
may take place just before or very soon after a menstru¬ 
ation. We begin to count the probable date of confine¬ 
ment from the last menstruation. The way to date is to 
find out on what day the last menstruation began, count 
forward nine months or three months backward, and add 
seven days, which is the probable duration of the men¬ 
struation ; when the date of the last menstruation is 
uncertain, add four and a half months to the date of 
quickening, which will give the probable date of confine¬ 
ment. There is always a possibility of a mistake, because 
conception may take place j ust before or soon after a men¬ 
strual period; that is, if conception did not occur soon 
after a menstruation, it probably took place just before 
the date of the next occurring period. 

As pregnancy advances the abdomen becomes larger 
(Fig. 28). About the fourth month the abdomen begins 
to enlarge, and the top of the womb can be felt above the 
brim of the pelvis; at the fifth month it is halfway to the 
navel; at the sixth month it is on a level with the 
navel; at the seventh month it is between the navel and 
the point of the breast-bone; at the eighth month it 
reaches the sternum ; and at the ninth month it gradually 
sinks into the abdomen, the pressure upon the organs 
within the chest is removed, and the woman breathes 


THE PATIENT. 


ii 7 

easier, though pressure at the same time is now put 
upon the lower organs, and it is difficult for her to 



Fig. 28.—Abdominal enlargement of pregnancy, showing varying heights of the 

fundus marked in weeks (Schaefer). 


walk. At the end of nine months the child is fully 
developed and labor takes place. 

The Fetus.—The fetus receives its nourishment from 
the mother through the blood-vessels of the placenta, 
which, when fully formed, consists of two portions, a 
fetal and maternal. These two portions are connected 





1 18 PRACTICAL POINTS IN NURSING . 

so closely that waste material from the child is carried 
to the mother, and nourishment from the mother is car¬ 
ried to the child very easily without there being any 
direct blood-communication between the mother and 
fetus; the blood is carried from the placenta to the fetus 
by the umbilical vein, and the two umbilical arteries carry 
the waste substance from the fetus to the mother. The 
umbilical cord is connected with the navel of the fetus 
and the placenta. When fully developed the cord is 
about 20 inches long, and is covered with a gelatinous 
substance called “ Wharton’s jelly,” which acts as a pro¬ 
tective. The cord contains two arteries and one vein. 
The arteries twist around the vein, which carries the 
blood from the placenta to the fetus, and it is returned 
by the arteries. After a while the fetus is enclosed in a 
membrane which gradually fills with what is called the 
“ amniotic fluid,” which is water containing albumin and 
certain salts. In this bag of waters the child floats, it 
being thus preserved from all injury. The bag of waters 
at the beginning of labor acts also as a wedge to dilate 
the mouth of the womb, and usually when it is fully 
dilated the membranes give way and the waters escape. 

Fetal Movements.—The movements of the fetus are 
felt between the fourth and the fifth month, and they gen¬ 
erally occur two weeks later in a woman who has been 
pregnant before. The supposition that the child—or 
“ fetus,” as it is called while in the womb—has no life 
until between the fourth and the fifth month, when its 
movements are felt by the mother, is entirely wrong. 
The child is living from the moment of conception, but 
its movements are not felt because, up to the first four 
and a half months, the womb, which is not sensitive, is 
not large enough to come in contact with the inner sur- 


THE PATIENT. 119 

face of the abdominal wall, which is fully endowed with 
sensibility. 

Disorders of Pregnancy.—Some of the disorders 
which may arise during pregnancy are—nausea, vomit¬ 
ing, constipation, diarrhea, leucorrhea, retention or in¬ 
continence of urine, salivation, swelling of the veins of 
the legs and thighs, swelling of the external parts, heart¬ 
burn, neuralgia, etc. The constipation is due to the 
pressure of the enlarged uterus on the intestines. The di¬ 
arrhea may be caused by the constipation, as there is then 
the packed feces. Pressure on the bladder is the cause 
of the constant desire to urinate, as the pressure inter¬ 
feres with the distention of the bladder and there is little 
room for the urine to accumulate. The pressure of the 
enlarged womb on the nerves of the pelvis, which supply 
the stomach, causes the nausea and vomiting. This dis¬ 
order disappears about the fourth month, when the womb 
rises out of the pelvis into the abdomen, but may appear 
again during- the last month, and then is probably due 
to renal inadequacy. The swelling of the limbs- and 
external parts is due to the amount of pressure put upon 
some of the blood-vessels, thus causing distention of 
other blood-vessels. 

Convulsions during pregnancy may be hysterical or 
epileptic, though they are generally uremic, caused by a 
disease of the kidneys, owing to the waste material of 
the body, which is disposed of by them, being retained 
in the body. The urine should be watched carefully ; 
the increase or decrease in its amount, and its paleness or 
deepness of color, etc., must be reported. The premon¬ 
itory symptoms which announce the convulsions in the 
majority of cases are — edema of the face, feet, and 
ankles, dull headache, dimness of vision, bright flashes 


120 


PRACTICAL POINTS IN NURSING. 


before the eyes, ringing in the ears, a confused condition 
of the mind, and the presence of albumin in the urine. 
The convulsions of pregnancy are treated in the same 
manner as uremic convulsions. 

Hemorrhage. —Should there be hemorrhage from the 
womb during pregnancy , the patient should be put to 
bed; the foot of the bed should be elevated and the 
head of the patient be lowered. The physician must 
then be sent for. The clots should be saved for the 
physician’s examination. Cold may be applied to the 
abdomen and the genitals. 

Termination of Pregnancy and Nurse’s Preparations 
for the Confinement.—We will now suppose that a nurse 
has been called to a confinement case. What is the first 
thing to be done ? She should find out if the patient is 
really in labor—if the pains are true pains or false pains. 
If false , the pains will be irregular and short; if true , 
they will be regular, first felt in the lower part of the 
back, and gradually increase to a certain intensity, then 
gradually subside. If the pains are the true labor-pains, 
the nurse should ask the patient at what time they 
began. The physician in charge of the case should then 
be notified. When the dilatation of the os is complete 
the physician is again notified. 

Preparation of the Patient. —The patient’s bowels should 
be emptied with soap-and-water enema, which will both 
clear the bowels and make labor easier by removing 
the fecal obstruction. If this is not done, the pressure 
put upon the rectum during the second stage will cause 
the bowels to empty of themselves, to the great annoy¬ 
ance of all in the room. 

A full bath is to be given if possible; if there is not 
time for the bath, the external parts should be washed 


THE PATIENT. 


121 


thoroughly. The hair of the patient should be braided 
in two braids. During the first stage she maybe allowed 
to walk about; but if it is night-time, she may lie down 
and try to get a little sleep between the pains. 

Preparation of the Bed .—The nurse should prepare the 
bed as follows : A large rubber sheet should be tightly 
pinned over the mattress, and covered with a sheet and 
a draw-sheet tightly tucked under the mattress; over 
these should be placed another rubber sheet and a draw- 
sheet, which must be tightly pinned at the four corners, 
so as not to be pulled out of place. If rubber sheets are 
not at hand, one may use newspapers, which can be 
burned afterward. The patient’s napkins should be 
soaked in a solution (i : 1000) of corrosive sublimate, 
and when dry folded in a towel and so kept until needed. 

Accessory Preparation.—Antiseptic pads can be made 
with cheese-cloth and common cotton-wool. The 
cheese-cloth is to be washed with soap and water, 
boiled, dried, and then cut it into as many pieces as the 
required number of pads (the number should be about 
thirty), each piece being about 16 inches square; into 
each piece is folded the cotton-wool, which should first 
be cut about 8 inches square; the cotton-wool is then 
doubled, which will make it 4 inches wide and 8 inches 
long, so that when the pad is made it will be 4 inches 
wide and 16 inches long. These pads are soaked thor¬ 
oughly in corrosive sublimate (1 : 1000), then dried, and 
kept in an antiseptic towel. When the pads are applied 
they should be pinned to the abdominal bandage back 
and front; when removed they must be burned. Prepa¬ 
rations should also be made for sterilizing the doctor’s 
aprons and instruments. Plenty of hot water should be 
at hand. 


122 


PRACTICAL POINTS IN NURSING. 


Other things that will be needed are—a pail, a fountain 
or Davidson syringe, safety-pins, scissors, a glass cath¬ 
eter, vaselin, stimulants, a fan, ergot (fluid extract), cor¬ 
rosive tablets, carbolic acid (i : 20); a binder of stout 
cotton about ij yards long and from 16 to 18 inches 
wide; a basket for the baby if there is no crib (a clothes- 
basket, even a foot-tub, has been brought into use, lined 
with a blanket or comforter and provided with a pillow); 
a blanket or a receiver for the baby; clothing for the 
baby; boiled vinegar, ice, cold water, a minim-glass, an 
ounce graduate, a spoon, a feeder; a basin for the after¬ 
birth, basins for solutions for the hands ; a bed-pan, soap, 
towels, a nail-brush, a hypodermic syringe, some old soft 
linen (old handkerchiefs answer nicely), and very strong 
thread or fine string for tying the cord. The string 
should be cut into twelve lengths, each 12 inches long; 
these pieces are divided into threes, which will give three 
four-strand pieces, each four to be knotted together at 
both ends. This gives three separate lengths, which, 
with the scissors, must be put into carbolic solution, and 
placed ready for the physician when he needs them. A 
word of caution to the nurse before proceeding: she 
should be scrupulously clean—she cannot be too clean. 
Septic material is carried by unclean hands and dirty fin¬ 
ger-nails, by clothing, instruments, or anything that is 
used about the patient that is not perfectly clean and 
sterilized. Hands must be washed in antiseptic solution 
each time anything is done for the patient before and 
after delivery. After birth the womb is like one large 
wound; even the most minute portion of septic material 
will be absorbed, and may cost the patient her life. 

Labor. —In a normal labor the head is born first— 
0 head presentation,” as it is called—but there are other 


THE PATIENT. 


123 


presentations, such as breech, brow, face, etc. For this 
reason the nurse must never attempt to take the respon¬ 
sibility of the case alone. She is not justified in so 
doing, because in large cities and country places a phy¬ 
sician can always be called in time. She does not know 
what complications may exist, and by undertaking the 
case alone she might lose the lives of both mother and 
child. Neither is she justified in making an examination 
to ascertain the presentation without orders from the at¬ 
tending physician. 

Under no consideration should a nurse take a case if 
she has been near a contagious case (medical or surgi¬ 
cal), typhoid fever included, to say nothing of having 
attended one. 

Stages of Normal Labor.—Labor is divided into 
three stages : First stage , from the beginning of the pains 
to the dilatation of the mouth of the womb ; second stage , 
from the complete dilatation of the mouth of the womb 
to the birth of the child; third stage, from the birth of 
the child to the birth of the placenta. 

First Stage .—The pains, which are caused by the con¬ 
traction of the muscles of the womb, are very severe, 
and they increase in intensity and duration as labor ad¬ 
vances. The first sign of labor is pain in the lower part 
of the back, which pain gradually comes forward to the 
front of the abdomen, extends down the thighs, and is 
of a bearing-down character. The pain at first is slight, 
but it increases until it reaches its height, then gradu¬ 
ally disappears. When the pain is at its height the 
mouth of the womb is stretched, and as the pain passes 
off it closes and the membranes recede. These pains at 
first occur regularly, about every twenty minutes or half 
hour, and this regularity helps to distinguish true labor- 


124 


PRACTICAL POINTS IN NURSING. 


pains from colic-pains, which are irregular. During the 
dilatation the mouth of the womb may be very slightly 
torn and the discharge of mucus be slightly tinged with 
blood; this is called the “ show,” and the physician must 
at once be notified. When the dilatation has reached a 
certain extent the bag of waters breaks. In this, the first 
stage, the patient may sit down or walk about, but she 
must be instructed not to bear down. 

Second Stage .—At the beginning of the second stage 
the nurse must put the patient to bed, roll up under 
the arms the night-dress and under-vest, fasten them 
with safety-pins, and pin a sheet around the waist, leav¬ 
ing it open at the right side. This arrangement will 
guard against exposure and keep the night-dress and 
under-vest clean. The nurse, in the absence of the 
physician, should remind the patient from time to time 
to urinate. Stimulants must not be given without the 
physician’s orders. When the pains come a roller-towel 
or a sheet may be tied around the foot of the bed, and 
the ends be given to the patient to pull upon. 

The stage of expulsion now begins: the pains change; 
they are stronger, are more frequent, and force the child 
out of the womb through the vagina. At the end of 
each pain the head of the child goes back, or “ retreats,” 
and the patient may think that something is wrong; but 
finally the head reaches a point where it does not retreat, 
and at last slips out. There is then a little rest, during 
which time the nurse can wipe the eyes of the child with 
a cloth wet with sterilized (boiled) water and cleanse 
its mouth. Another severe pain now comes, and the 
shoulders and the rest of the body are born, accom¬ 
panied with a rush of amniotic fluid and of blood 
from the placenta. This discharge may cause faintness 


THE EAT/ENT. 


125 


due to the blood leaving the brain, for, the pressure upon 
the abdominal organs being removed, the blood-vessels 
are dilated, and the blood rushes to them; there may 
also be a chill, owing to a certain amount of nervous re¬ 
action. The womb now contracts on the placenta, which 
accomplishes its separation, thus shutting off the supply 
of oxygen to the child. This causes the child to gasp, 
and respiration is started. 

Ether is sometimes given during the second stage to 
lessen or dull the pain. The cone, sprinkled with a small 
quantity of ether, is held over the mouth and nose when 
the pain begins, and taken off as the pain subsides. 

Third Stage .—After the birth of the child there is 
usually a rest of about fifteen or twenty minutes, when 
the pains begin again, and the after-birth and membranes 
are expelled. This is the third stage. When the child 
is born the womb contracts, and it can be felt like a 
round hard ball. The physician may ask the nurse to 
hold the womb; this is best done with the left hand. 
The abdomen is depressed so as to allow the womb to 
rest in the palm of the operator’s hand, the fingers being 
then behind and the thumb in front of the womb; in 
this way the womb is firmly grasped. After the phy¬ 
sician has tied and cut the cord he generally holds the 
womb until the placenta comes away; after the bed has 
been cleaned the pad and binder are applied. If the baby 
is all right, it is wrapped in the receiving blanket and put 
away and the nurse attends to the mother. 

After all is over the womb gradually decreases in 
size and returns to its normal condition ( involution ), 
which usually takes from six to twelve weeks; but 
when involution is not complete, when the womb re¬ 
mains large and does not return to its normal shape, this 


126 


PRACTICAL POINTS IN NURSING . 


condition is called subinvolution y which may result in 
inflammation of the lining membrane of the womb. 

Duration of Labor.—The duration of an ordinary 
normal labor is from seventeen to twenty-four hours for 
a first child, but is less long for a second. The pains, as 
a rule, begin in the evening, the larger number of births 
taking place during the small hours of the morning. 

Conduct of Normal Labor.—Now, one may not 
always get a favorable state of affairs. The baby may 
be born before the physician comes, which accident is 
not uncommon with women who have borne children 
before. 

The patient should be put to bed on her left side; 
the perineum should be supported to prevent the head 
emerging too suddenly, which support will relieve the 
strain upon the perineum and lessen the danger of its 
being torn. This regulation of the expulsion is done 
by the nurse standing behind the patient at the left side 
of the bed and laying her right hand on the external 
genitals, which will bring the fingers on the left, the 
thumb on the right side, and the palm of the hand 
pressed against the perineum (Fig. 29). The head is to 

be pushed rather upward, so that 
the chin of the child will rest 
against its chest and relieve the 
strain on the perineum. When 
the head is born the nurse should 
see if the cord is wound around 
the child’s neck; if so, it should 
be slipped over the head from 
behind ; if this is not done quickly, the circulation of 
blood in the cord will stop and the child will die. 

If there is a membrane over the child’s face, it must be 



Fig 29.—Regulating expul¬ 
sion of the head with the fin¬ 
gers of one hand against the 
occiput. 



THE PATIENT. 


127 


torn immediately or the child will suffocate. This is known 
as being born with a veil or “ caul,” which is due to the 
child being born with high rupture of the membranes. 
The eyes, nose, and mouth of the child must be cleared 
of mucus. The perineum must again be supported when 
the shoulders are being born, because it is stretched 
more than when the head passes through, and there is 
more danger of its being torn. Moreover, if it was 
slightly torn when the head was born, the tear may be 
made considerably larger. If the child does not cry 
and its mouth and nose are perfectly clear, it may be 
patted on the back with the hand or some stimulant may 
be rubbed on its back; if this does not make it cry, 
then the cord may be tied tightly in two places—the 
first ligature being 1 \ inches from the child, and the sec¬ 
ond 1^- inches from the first—and cut between the two 
ligatures. The child should then be put first into hot 
and then into cold water, or artificial respiration may be 
practised by placing the child upon the bed with its back 
slightly arched by means of a folded towel or sheet. 
The nurse grasps a forearm in each hand, presses the 
arms lightly against the lower part of the chest to effect 
expiration, the arms are then slowly lifted above the 
head, which movement causes inspiration by raising the 
ribs and expanding the chest. These movements should 
be repeated ten times a minute. This is Sylvester’s 
method, but it is of little value here. 

Schultze’s method is very good. The child is held 
by the upper arms and shoulders, with its back to 
the nurse. It is then swung upward with the head 
downward above the nurse’s head; the child is held in 
this position while the nurse counts five, when the first 
position is resumed. The first movement tends to ele- 


128 


PRACTICAL POINTS IN NURSING . 


vate the ribs, while in the second they are depressed. 
When the baby begins to breathe it must be wrapped in 
a warm blanket and be put in a warm place. 

We will now suppose that the birth has been perfectly 
normal and that the nurse is still alone. As soon as the 
baby is born the nurse should grasp the womb firmly 
with the left hand and keep it contracted. When the 
pulsation in the cord ceases she must tie and cut the 
cord. She should then wrap the child in the receiver, 
lay it away, and attend to the mother, having first wiped 
the hands of the child to prevent any substance on them 
being carried to the eyes. 

When the after-birth (placenta) is being expelled, the 
nurse can assist by pressing the womb evenly on all 
sides; as the placenta passes out, the nurse should turn 
it around so as to make a twist of the membranes, which 
procedure will prevent them from tearing and will bring 
them all away together. The placenta should be put in 
a basin and kept for the physician’s inspection, after which 
it can be burned or buried. The patient may be given a 
teaspoonful of the fluid extract of ergot, which will con¬ 
tract the blood-vessels of the womb and keep up the 
contraction, thereby preventing hemorrhage. When the 
womb is hard and firm the patient may hold it while the 
genitals are bathed with an antiseptic solution. The pa¬ 
tient is then turned on her side and her back bathed. 

The soiled sheet and rubber cloth are removed by 
folding one side as closely as possible up to the back 
of the patient; the binder is arranged on the bed, the 
farther end being rolled up and placed next the patient, 
so that when she is turned over on the other side she 
rests on the clean permanent bed and the binder. The 
soiled sheet and rubber are removed and the binder 


THE TATI ENT. 


129 


straightened out. The nurse should keep up the con¬ 
tractions of the womb for about an hour longer, when 
it will be safe to pin the binder tightly about the hips, 
beginning at the bottom and working upward. The pin¬ 
ning should be done evenly, the pins being about il 
inches apart. The binder may be fitted to the waist by 
taking in darts at the sides, and perineal straps may be 
applied to prevent it slipping up. The binder should 
extend from the hips to the waist-line. An antiseptic 
napkin should be laid over the genitals. The patient 
may be given a drink of milk or a cup of weak tea, 
which is generally preferred; when everything is quiet 
the patient will probably go to sleep. The nurse should 
move about the room quietly, keep out visitors, and, 
lastly, watch for hemorrhage. 

Management of the Puerperium.—The room should 
be kept bright and cheerful, the air fresh and pure. The 
nurse should keep a record of the temperature, pulse, 
respirations, sleep, amount of diet the patient takes, and 
the condition of the bladder, bowels, and lochia. 

The length of time that the patient remains in bed 
depends upon the amount of progress made and whether 
or not there is any blood in the lochia. The sitting up 
in bed will be gradual. Some physicians have the 
patient propped up in bed on the third day, though as a 
rule she does not leave her bed until the second week. 
The return to the customary mode of living is gradual. 
The period of lying-in is usually about four weeks. The 
patient must not be allowed to sit up in bed without the 
physician’s orders, because sitting up or excitement of 
any kind may bring on a hemorrhage. 

Catheterization .—The nurse should see that the patient 
urinates six hours after labor; she should not wait for 


9 


130 PRACTICAL POINTS IN NURSING. 

the patient to express a desire to do so, but should 
remind her. There may at first be a little difficulty in 
urinating, but before passing the catheter the nurse 
should try any of the means usually resorted to in in¬ 
ducing the urine to flow—hot water in the bed-pan, the 
sound of running water from a faucet or a pitcher, or 
allowed to run down over the parts (cold water succeeds 
with some women), or hot cloths placed over the lower 
part of the abdomen; or the patient may turn over on 
her hands and knees: if these means fail, the nurse must 
then resort to the catheter. 

Lochia .—The lochia are the discharges that follow 
childbirth; for the first few days they are a bright red, 
which gradually becomes paler and paler until they are 
almost transparent, and finally cease. The lochia may 
last two weeks or longer, the length of time differing 
with each patient. Any odor or departure from the 
normal must be promptly reported. 

Napkins .—The napkins must be changed during the 
first few days every three hours, taking care that they 
have previously been soaked in some antiseptic solution. 
If is very easy at this time, if strict antiseptic precautions 
are not used, for germs to enter the uterine cavity or 
peritoneum, the result being puerperal septicemia. The 
parts must be kept clean and must be washed with anti¬ 
septic solution three times a day. 

Douches must not be given without direct orders from 
the attending physician. 

Diet .—The diet should be liquid for the first twenty- 
four hours; after that there may be given soft, light, 
easily-digested food. The bowels must be moved by 
the third day. 

Temperature and Pulse .—The temperature may rise 


THE PATIENT. 


131 

slightly during the first twenty-four hours after child¬ 
birth ; then it should descend to normal, and so remain. 
A rise of temperature after childbirth may be due to 
constipation, exhaustion after labor, nervousness, or 
threatened abscess of the breasts; or it may indicate 
sepsis. Should sepsis be indicated, other symptoms, 
such as decrease of the lochia, offensive odor from the 
discharges, and distention of the abdomen, will be pres¬ 
ent. The pulse may, on the contrary, be found very 
low, sometimes as low as 50 beats. A low pulse is not 
at all serious, but must be noted. 

After-pains are caused by the womb contracting, and 
they generally last four or five days. Nursing will often 
produce severe pains, because of the sympathetic rela¬ 
tion between the breast and uterus, and by putting the 
child to the breast involution is hastened. 

Lactation .—The child must be put to the breast six 
or eight hours after birth, after the mother has rested. 
The milk does not generally appear until the third day 
after delivery, but the breast contains a secretion called 
“ colostrum,” which acts as a laxative and clears the 
bowels of the child; putting the child to the breast early 
also teaches him to nurse and assists in forming the nip¬ 
ples. The breasts must be nursed alternately regularly 
every two hours during the day, and the nipples must be 
washed before and after each nursing with water to which 
a little borax has been added. If the nipples are soft 
and tender, they may be hardened by bathing them with 
equal parts of alcohol and water. 

Care of the Breasts .—If the breasts are sore and pain¬ 
ful, this condition must be reported to the physician: in 
the mean time the nurse may rub the breast with warm 
sweet oil and apply gentle massage, massaging from the 


i 3 2 


PRACTICAL POINTS IN NURSING. 


base toward the nipple. The pulse and temperature 
should be taken. A cracked nipple must promptly be 
attended to, the child nursing from the other breast; the 
nipple must be kept perfectly clean; the milk must be 
drawn from the sore-nipple breast with a breast-pump, 
and the breast massaged gently to relieve the tight feel¬ 
ing. The nipple usually heals after a rest of one or two 
days. The bowels must be kept open. If the milk- 
secretion is scanty, the mother’s diet should be a mixed 
one, milk entering very largely into its composition. Al¬ 
cohol, such as beer or porter, does not make milk, as is 
commonly supposed, but tends only to fatten the mother. 

Breast-bandage .—The breast-bandage most commonly 
used is made with three toilet napkins or with two pieces 
of muslin. The two napkins are pinned together to form 
a V, and are fastened to the middle of one end of the 
third napkin (Fig. 30) after the manner of the Y-bandage. 

The single napkin is passed across the back, which 
brings the V-shaped napkins directly to the side of the 

breast; these two napkins are carried 
across the chest, one below the breasts, 
the other above, and pinned to the free 
end of the napkin crossing the back. 
This bandage holds up the breasts. The 
muslin compress is arranged in exactly 
the same way, though only two pieces 
are needed (each folded and about 6 
inches wide), one small piece to pass 
under the back, the second piece large enough to go 
twice across the chest in the shape of a double V ( <> ), 
and pinned to the ends of the small piece. If the baby is 
nursing, this bandage is left open ; if not, a pad of cotton 
is placed between the breasts, and the edges are pinned 



Fig. 30.—Y-bandage. 








THE PA IT ENT. 


133 


together with small safety-pins. Straps of muslin passed 
over the shoulders and pinned back and front will keep 
the bandage in position. 

Pathology of the Puerperium.—Some of the com¬ 
plications which may arise after childbirth are hemor- 
rhage, puerperal insanity, eclampsia, and phlegmasia 
dolens. 

Hemorrhages .—Hemorrhage after childbirth is called 
“ post-partum hemorrhage,” and is due to the womb re¬ 
laxing. Ihe symptoms of post-partum hemorrhage are 
restlessness or tossing of the patient in bed, faintness, 
pallor, a demand for air, a sense of dizziness, shortness 
of breath, and a weak, rapid pulse. The restlessness 
alone should put the nurse on her guard and lead her 
to investigate. The nurse should put one hand on the 
abdomen and feel for the womb by pressing on the ab¬ 
domen ; if the womb is found, grasp and squeeze it hard, 
squeezing out the clots; the womb may not be found, 
owing to its relaxed condition, or it may be found large 
and firm, owing to the formation of a blood-clot which pre¬ 
vents the womb contracting and keeps the blood-vessels 
open. The nurse should call for assistance and send 
some one for the family physician. If he lives at a dis¬ 
tance, the nurse is justified in sending for the nearest 
physician. The assistant should be directed to elevate 
the foot of the bed (to send the blood back to the heart 
and brain) and to bring the basin of antiseptic solution, 
vinegar, gauze, or a clean handkerchief. The nurse 
should wash her free hand in the antiseptic solution and 
clean out the clots from the womb; then the gauze or 
handkerchief should be soaked in the vinegar, be carried 
well up into the uterine cavity, and squeezed. The vin¬ 
egar will flow back over the walls of the womb and the 


134 


PRACTICAL POINTS IN NURSING. 


vagina and cause the blood-vessels to contract This 
treatment should be continued until the bleeding stops. 
Ergot may in extreme cases be given hypodermatically, in¬ 
jected either into the upper part of the thigh or the abdo¬ 
men. A hot douche of water and vinegar, equal parts, its 
temperature being about 118° F. or 120° F., will also con¬ 
tract the blood-vessels. The nurse should see that the blad¬ 
der is empty; she should also watch for collapse and give 
stimulants. Morphia grain) may be given to secure 
rest. Kneading of the womb must be kept up all the 
time with one hand. The application of ice is not ad¬ 
visable, because ice is not clean, and it may be the means 
of introducing septic material into the cavity of the 
womb. Vinegar is the best; it is an astringent, it can 
always be had, it is readily applied, and its action is 
generally very prompt. 

When the bleeding has stopped the kneading must 
still be continued until the womb is firm and small. 
The foot of the bed and the hips should be kept elevated, 
and the patient should not be left alone for a moment. 
This is one of the cases where prompt action, a calm 
and collected mind, and a steady hand are absolutely 
necessary. It is always a safe plan to have close at hand 
vinegar, very hot water, a syringe, and gauze or clean 
soft rags which have previously been sterilized in the 
oven for a number of hours after delivery, in case this 
accident should happen. The nurse is then prepared for 
prompt action, for it does not take long for a patient to 
bleed to death. 

Septicemia .—Puerperal septicemia is caused by neglect 
of antiseptic cleanliness on the part of the attendant (see 
p. 165). It begins with a chill or a continued chilly feel¬ 
ing, followed by a rise of temperature and accelerated 


THE PATIENT. 


135 


pulse, a bad odor from, and probably suppression of, the 
lochia, cold, clammy sweat, anxious expression, and dis¬ 
tention of the abdomen. The smallest rise of temper¬ 
ature should make the nurse watchful; she should notify 
the physician, move the patient’s bowels, give a vaginal 
douche of 1 : 5000 corrosive sublimate, and apply tur¬ 
pentine fomentations to the abdomen. The patient 
should be stimulated if necessary. 

Insanity .—The treatment of puerperal insanity or mel¬ 
ancholia lies in keeping the patient perfectly quiet and 
preventing her from harming herself. The air of the 
room must be kept fresh and pure; the patient’s strength 
supported with nourishing food; baths may be given 
to promote activity of the skin; the bowels must be 
kept open ; and any article or any person that tends to 
excite the patient must be removed from her sight. The 
baby is taken from the breast when the symptoms first 
appear, and must be taken from the room. Bed-sores 
must be guarded against, and a strict watch must be 
kept over the patient; if allowed to be up and around, 
she must not be permitted to go out of the nurse’s sight. 
With a little tact the nurse can manage this surveillance 
without letting the patient think that she is being 
watched. The causes of puerperal insanity are many, 
and a good recovery depends chiefly upon the nursing. 

Eclampsia (Convulsions ').—In event of convulsions the 
nurse must send at once for the attending physician, and 
put something in the mouth of the patient to prevent 
her biting her tongue. A hot pack or a vapor-bath may 
be given, and ice be applied to the head. Morphia (£ 
grain) will stimulate the heart’s action, induce perspira¬ 
tion, and quiet the patient. 

Phlegmasia Dolens .—Phlegmasia dolens, or milk-leg, is 


136 


PRACTICAL POINTS IN NURSING. 


due to a blood-clot forming in a vein. There is swelling 
of the affected limb and pain, and its surface is white and 
drawn. The disease may be ushered in with a chill or a 
chilly feeling and a rise of temperature and pulse. The 
patient must be kept on her back, and the limb be ele¬ 
vated and kept warm by wrapping it in cotton-wool. 
Recovery takes place with the absorption of the clot. 

Thrombosis .—Thrombosis is a clot of blood in a vein 
obstructing the circulation. It is generally caused by 
the patient walking, or even standing, too soon after an 
illness. Clotting may also take place after childbirth. 
There is swelling of the part, which swelling goes down 
as the clot is absorbed. But if absorption does not take 
place, if the clot is swept onward in the circulation of 
the blood to the right side of the heart, sudden death 
results from the obstruction of the pulmonary artery. 
This clotting is called embolism. 

Extra-uterine Pregnancy.—Extra-uterine pregnancy 
is development of the ovum outside the womb, either in 
the Fallopian tube, the ovary, or the abdominal cavity, 
but generally in the Fallopian tube. As the ovum grows 
the walls of the tube become very weak and thin, until 
at last, about the fifth, eighth, or twelfth week, they rup¬ 
ture. There is then sudden pain in the affected side, 
together with all the symptoms of internal hemorrhage 
and collapse. 

Cesarean Section.—Cesarean section is the removal 
of the child from the womb by abdominal incision. This 
operation is performed to save the life of the child should 
it be living after the death of the mother, or in case 
there is some pelvic deformity or tumors complicating 
natural delivery. 


THE PATIENT. 


137 


III. NURSING IN GYNECOLOGIC CASES. 

Preparation for Gynecologic Examination.—To pre¬ 
pare a patient for examination the genital parts should 
be cleansed and the bladder and bowels be emptied. 
The womb lies between the bladder and the rectum, and 
the distention of either of these organs will alter the 
position of the womb. A douche must not be given 
before an examination, because the surgeon will want 
to see the character of the discharge. All bands around 
the waist and the corset must be loosened; a single tight 
band around the waist will crowd down the contents 
of the abdomen and displace the uterus. Around the 
patient is thrown a sheet, beneath which she can raise 
her clothing above the waist, and then step upon a chair 
and thence to the edge of the operating-table without 
there being the slightest exposure. 

For the examination there is needed a small table cov¬ 
ered with a shawl, a rug, and a comfortable or blanket; 
over these a sheet is spread and a pillow is placed for 
the patient’s head. There should be at hand a sheet to 
cover the patient; a chair by the table for her to step 
upon ; a table, covered with a towel, on which are placed 
two bowls, one containing corrosive-sublimate solution 
(1 : 1000), and the other containing warm water; a piece 
of soap (castile) or vaselin ; and towels. 

Positions for Examination.—The four positions for 
examinations, and also for operations, are the dorsal, the 
Sims, the knee-chest, and the upright. 

Dorsal Position .—The patient lies upon her back with 
the knees drawn up and separated ; the hips are brought 
down near the edge of the table, leaving sufficient room 


138 PRACTICAL POINTS IN NURSING. 

for the heels to rest together comfortably, 8 or 10 inches 
apart, without slipping from the table. The clothing is 
pushed above the knees and the sheet hangs in front, 


Fig. 31.—Dorsal position, with patient arranged for examination (Codman and 

Shurtleff). 

completely covering the patient’s legs and avoiding all 
exposure (Fig. 31). 

Sims Position .—In the Sims position (Figs. 32, 33 ) the 
patient lies on the left side of her chest, with her head 
and left cheek resting on a low pillow, and the left arm 
is drawn behind the body or hangs over the edge of the 
table. The hips are brought down to the left-hand cor¬ 
ner of the table, so that her body lies diagonally across 
it, the head and shoulders being at the right-hand side, 
with the right hand and arm hanging over the table 
edge. The thighs are flexed upon the body, the right 
knee being so bent that it lies just above the left, and the 











































































THE TAT/ENT. 


139 


feet rest upon a board extending from the right-hand 
corner of the table (Fig. 32). The patient is covered with 
a sheet, and the buttocks are covered with two towels, 
one to cover each side, their 
upper ends being tucked 
under the clothing, the 
lower ends being tucked 
between and under the legs, 
thus simply exposing the 
entrance to the vagina (Fig. 

33) . This position is one 
in which a practical illus¬ 
tration is needed before one 
can fully understand how 
to place the patient, and 
also how to arrange the 
towels. The Sims position 
causes the vagina to be 
filled with air and places 
the mouth of the womb 
within easy reach, so that it 
can more clearly be seen. 

Knee-chcst Position .—In the knee-chest position (Fig. 

34) the patient first kneels on the edge of the table, then 
bends forward and rests her chest on a low pillow, her 
head lying just beyond, so that her back slopes down 
evenly, her arms clasping the sides of the table. The 
clothing is drawn above the waist, and the patient is 
covered with a sheet. In this position the abdominal 
organs are thrown down toward the diaphragm; the 
air enters the vagina and balloons it out, so to speak, 
so that there is an unobstructed view of the canal and 
the cervix. 



Fig. 32.—Sims’s position for tamponing and 
curetting Dickinson). 








































140 PRACTICAL POINTS IN NURSING. 

Upright Position .—In the upright position the clothing 
of the patient is drawn up, and around the waist is pinned 



Fig. 33.—Arrangement of the towels for examination with patient in the Sims 

position. 


a sheet extending to the floor. The patient stands with 
limbs separated, one foot resting on a stool or the rung 
of a chair. 



Fig. 34.— Knee-chest position. 


Preparation for Operation.—For gynecologic opera¬ 
tions the nurse makes her preparations in the same 


















































THE PATIENT. 


141 

manner as for abdominal operations, using the same 
antiseptic precautions. In an emergency, when a slight 
operation is to be performed with the patient in bed, 
there will be needed a table or a chair covered with a 



Fig. 35.—Table equipped with basins, brushes, antiseptics, etc. for the physician’s 

use (Dickinson). 

sterilized towel or sheet for the instrument-tray, bowls, 
hot and cold water, a fountain syringe filled with cor¬ 
rosive-sublimate solution (1 : 3000) and a wide board 
or an ironing-board for insertion between the mat¬ 
tress and sheet (thus making a hard surface for the 




142 


PRACTICAL POINTS IN NURSING. 


patient to lie upon), a chair for the surgeon, soap, and 
a nail-brush. 

A piece of rubber cloth, or oilcloth, or newspapers 
will serve for the pad. The material used is folded at 
the top and sides, covered with a towel, and the unfolded 
end draped into a pail or a wash-tub. When the patient 
is etherized the bed is turned toward the window to 
afford the surgeon a good light—the northern light if 
possible. A bay window must be avoided, because it 
gives cross lights. 

The limbs are flexed, the hips are brought down to 
the edge of the bed, and the pad is placed under them, 
so that the water used in bathing the external parts is 
conducted by the cloth into the pail or the tub. When 
holding the patient’s limbs the nurse should let the heel 
of one foot rest in the palm of her hand; the knee of 



Fig. 36. —Arrangement of towels for examination, showing introduction of the specu¬ 
lum with patient in the Sims position. 


the patient will then rest against the chest of the nurse, 
whose free hand is passed over and holds the other 
limb in position at the knee. If the patient is in the 
Sims position and the nurse is asked to hold the specu- 











































THE PATIENT. 


143 


lum, it should be held with her right hand in the exact 
position in which the surgeon has placed it (Fig. 36), 
her left hand, being passed over the patient’s thigh, 
should raise the right buttock. 

After-care.—The after-care of gynecologic cases lies 
mainly in procuring absolute rest and quiet. The pa¬ 
tient must see no visitors without permission from the 
surgeon. The limbs are generally tied together for 
the first few days, especially after an operation on 
a lacerated perineum, to prevent the external stitches 
(sutures) giving way in case the patient should toss 
about. 

The genital parts must be kept perfectly clean, and 
strict antisepsis must be observed, as septic material 
readily finds access. After passing the catheter the nurse 
should be careful that when removing it the urine does 
not drop on the stitches; the parts are afterward sprayed 
with the ordered solution and dried. When giving 
douches the nurse must insert the tube carefully and 
away from the stitches, and after the douche is over 
she should softly wipe the vulva diy with sterilized 
gauze or cotton. The same care must be used when 
giving enemas, so that the rectal and vaginal stitches 
are not broken by the tube. The patient must be 
instructed not to strain when the bowels are being moved, 
or the stitches may break. If the uterus is packed with 
gauze, the pulse and temperature are taken every two 
hours; should the temperature rise to ioi° F., the pack¬ 
ing is removed. 

Diet .—The diet is liquid until after the third day, 
when the bowels will have been moved; then, if all is 
well, the amount of food is increased. 

Vaginal Tampons .—A vaginal tampon is made of 


144 


PRACTICAL POINTS IN NURSING. 


absorbent cotton, lamb’s wool, or gauze, and is about 
7 inches long, ij inches wide, and ^ inch thick, folded 
and tied in the middle with strong white thread or fine 
twine, leaving long ends with which to remove the tam¬ 
pon. The kite-tail tampon is made by fastening several 
of these pieces of cotton to a piece of thread about 2 
inches apart. When the tampon is made the pledgets 
of cotton are soaked thoroughly in water, then in gly¬ 
cerin, after which they are put away; or they may be 
sterilized and the tampon put away in an aseptic glass 
jar. 

Vaginal Dressings .—Vaginal dressings are made of 
strips of absorbent cotton, lambs’ wool, or gauze (three 
thicknesses), i^- inches in length and width. They are 
prepared for use in the same way as the tampons. 

Each surgeon has his favorite dressings, and after see¬ 
ing a dressing done once the nurse should know what to 
prepare for him the next time. 

IV. DUTIES OF THE NURSE IN GENERAL 
SURGICAL CASES. 

We will now consider the preparations for an opera¬ 
tion, and the care of the patient before, during, and after 
operation. 

Preparation of the Operating-room.—The directions 
for the preparation for an operation will be given by the 
surgeon in charge. In some houses the nurse may 
have a separate room, or even the kitchen, for the 
operating-room, while in others she will have to pre¬ 
pare part of the patient’s bed-room. In the latter case 
the brightest end of the room should be prepared for 
the operation, to afford the surgeons plenty of light. A 
screen must be put up before the bed, so that the patient 


THE PATIENT. 


145 


will not see the preparations; some patients, however, 
will take a great interest in all that is going on, while 
others will be exceedingly nervous. The nurse should 
remove from the room all movable furniture; lay oil¬ 
cloth, or newspapers covered with a sheet, over and pin 
securely to the carpet, and across the window fasten a 
curtain or newspapers, so that the operation cannot be 
viewed from the opposite side of the street. The re¬ 
maining furniture and window-frames should be washed 
with carbolic-acid solution (1 : 20), and on the morning 
of the operation should be dusted with a cloth wrung 
out of the solution. The things necessary for the opera¬ 
tion can be placed on the operating-table, covered with ti 
sheet, and be left outside the room until the patient is 
partly etherized, when they may be carried in. 

If a separate room may be had, one with a northern 
light is to be preferred, and, if possible, it should be far 
away from the bath-room for aseptic reasons. All un¬ 
necessary furniture being removed, the hangings must be 
taken down, the room thoroughly swept, and the walls 
and remaining furniture washed with carbolic-acid solu¬ 
tion (1 : 20) and exposed to the action of the sun and air 
for about twelve hours, when the windows are to be 
closed, the room thoroughly dusted with a damp cloth, 
and not again disturbed. The kitchen makes the best 
operating-room ; it is warm, hot and cold water is close 
at hand, and one is not afraid of soiling carpets or 
hangings. 

Operating-table .—The operating-table should not be 
wider than 25 inches, nor higher than 37 inches, because 
if low and wide the surgeons will have to stoop and 
bend forward. A kitchen table or a dining-room table 
with the leaves let down, and a small table at one end 


10 


146 PRACTICAL POINTS IN NURSING. 

for the patient’s head, will make a good narrow ope¬ 
rating-table; or three chairs, with two planks, a leaf 
from an extension table, or an ironing-board laid across 
them, may suffice. 

The table may be covered with rubber cloth, oilcloth, 
or even with newspapers, two sheets, and a blanket. A 
word of caution here: the nurse should not use any 
old blanket or comfortable to cover the operating-table; 
it may be filled with germs, which must be avoided. 

Two wooden chairs should be at hand in case the 
Trendelenburg position is necessary, and two wooden 
boxes for the surgeons to stand upon when using this 
position. 

Preparations for the Operation.—The evening be¬ 
fore the operation the nurse should boil a wash-boiler 
full of water and set it in covered pitchers to cool, the 
wash-boiler and pitchers having first been made thor¬ 
oughly aseptic. 

On the morning of the operation the nurse should 
sterilize in the boiler or in an oven six sheets, two 
blankets, twelve towels, and twelve sponges. She 
should not take the best towels in the house, because 
they are spoiled by the solutions and the blood. There 
will be needed six bowls, which may be of agate-ware 
or be the ordinary bed-room china bowls—one for per¬ 
manganate of potash, one for oxalic acid, one for steril¬ 
ized hot water, one for corrosive sublimate, one for the 
surgeons’ hands, and one for the vomit. If there are no 
pails for the sponges, the hot and cold water may be 
carried in the bed-room toilet pitchers. After the hands 
have been made aseptic and the part washed the perman¬ 
ganate and oxalic acid can be disposed of and the bowls 
be used for the sponges. Two tables will be needed— 


THE PATIENT 


147 


one for the instruments, the other for the assistant—which 
can be improvised in the same way as was done for the 
operating-table (p. 146), and covered with sheets or towels. 
There will also be needed a pail or a wash-tub for the 
soiled water, a tin dish or a flat bake-pan for the instru¬ 
ments, brandy, a hypodermic syringe (which must be 
placed in a bowl containing carbolic-acid 1 : 20 solution), 
and the syringe be filled with the solution, strychnia tab¬ 
lets grain), a small tumbler, a Davidson or a fountain 
syringe, common table-salt for salt-solution, sheet-wad- 
ding, absorbent cotton, bandages, sterilized gauze, safety- 
pins, rubber tubing for a tourniquet, two new nail-brushes, 
castile soap, green soap, a razor, hot-water bottles, two 
blankets, alcohol, matches, and twelve gauze sponges 
of various sizes—three 2 inches square, three 4 inches 
square, three 6 inches square, and three 8 inches square. 

Sterilization .—Sterilization may either be dry or moist; 
moist heat is preferable, because it is more thorough and 
more penetrating than dry heat. For dry sterilization 
the clothing and dressings are placed in covered tin 
pans in the oven, the temperature ranging from 160° to 
212 0 F. For moist or steam sterilization an ordinary 
wash-boiler is used. Water is poured in to the depth 
of about 6 inches; sticks or bricks, placed crosswise, are 
built up above the level of the water, and upon them rest 
the clothing and dressings. 

For both these methods the heat must be continued 
for fully one hour before the operation. The instru¬ 
ments are wrapped in a towel and allowed to boil for 
ten minutes in a tin pail or a kettle of boiling water to 
which has been added 2 teaspoonsful of washing-soda 
to each pint of water, to prevent them from rusting. 
There must be left hanging out of the kettle one end 


148 


PRACTICAL POINTS IN NURSING. 


of the towel, by which to lift out the instruments. The 
water must boil some time before the instruments are 
placed in it. 

Operative Position .—The most popular position for ab¬ 



dominal operations is the Trendelenburg (Fig. 37). This 
position is one in which the knees of the patient are con¬ 
siderably higher than the head, the body slanting upward 
from the shoulders; the intestines are thus thrown down 








THE PATIENT. 


149 


toward the diaphragm, giving the surgeon a clear view 
of the pelvic organs. In the absence of a Trendelenburg 
table the position can readily be obtained by raising the 
lower end of the operating-table and placing chairs or 
boxes under its feet; or a wooden chair or a high box 
can be secured to the operating-table and covered with 
sterilized sheets. 

Preparation of Patient.—If the nurse has from 
twenty-four to thirty-six hours in which to prepare the 
patient for operation, she should give the patient, the day 
before the operation, a full bath and a cathartic of either 
castor oil, citrate of magnesia, salts, or compound lico¬ 
rice powder. The diet must be nourishing and light. 
Milk should not be given before an abdominal operation, 
because the stomach does not digest it thoroughly, and 
its curds may remain in the intestines and act as an irri¬ 
tant. Gruel is best given; it is nourishing and easily 
digested. 

The part to be operated on must be shaved (if the 
patient is very nervous it is generally well to leave this 
operation until she is partly etherized). After the shaving, 
the part is thoroughly cleansed with soap and water and 
a nail-brush, then with ether, which removes all oily and 
fatty substances, then with warm corrosive-sublimate so¬ 
lution (1 : 1000), after which cleansing a pad of sterilized 
gauze, absorbent cotton, or a towel is wrung out of the 
solution, applied over the part, and held in place with a 
sterilized bandage and perineal straps. This pad is not 
removed until the surgeon is ready to operate. The 
patient must be instructed not to put her fingers under¬ 
neath the dressing or to disturb it in any way. 

No definite rules can be laid down for the surgical 
bath, as surgeons differ in their method of preparing 


150 


PRACTICAL POINTS IN NURSING. 


patients for operation. The bath may be given in the 
manner just described, while some surgeons will direct 
the application of a poultice of green soap , which is re¬ 
moved early on the morning of the operation, the part 
beincr scrubbed with hot water and a brush to remove 

o 

the soap, and a warm corrosive-sublimate poultice (i : 
1000) applied. 

On the morning of the operation the patient should 
be given a simple enema to clear the bowels, and a 
sponge-bath; the nurse should then put on the patient 
a clean under-vest, night-gown, and stockings, and braid 
the hair in two braids; she should also remove from the 
patient all rings and ear-rings; also false teeth, whether 
a whole or a partial set, as there is danger of their being 
swallowed, and put them away in a tumbler of cold 
water. Two hours before the operation the patient 
should be given a stimulating enema of whisky (i ounce) 
and warm water (2 ounces). This enema is to be fol¬ 
lowed in one hour with atropia (y^o of a grain), which 
acts as a sedative and lessens the irritability of the stom¬ 
ach caused by the ether; it also lessens the secretions of 
the mouth and throat and prevents the throat filling up 
with phlegm. Both these stimulants should be given by 
enema, because if given by the mouth they might stay in 
the stomach unabsorbed, and the patient would vomit 
them when under ether. No food must be given after 
midnight, unless the operation is to be performed late in 
the day—about noon-time or in the afternoon—in which 
case the patient may have, six hours before, beef-tea, 
gruel, or coffee. Milk should not be given, as it is very 
apt to curdle and stay in the stomach, and, should the 
patient vomit while under ether, the curds may get into 
the larynx and trachea and choking result. The cath- 


THE PATIENT. 


151 

eter should be passed before etherization if the operation 
is abdominal, even if the patient has urinated a few min¬ 
utes before, and the nurse should be sure that the blad¬ 
der is empty. 

Special operations, abdominal and gynecologic, call 
for special directions, which will be given by the surgeon 
in charge. 

Duties of the Nurse in Emergency Cases.—We will 
consider the preparation for an emergency operation in a 
very poor family, where there are no conveniences. We 
will presume the case to be one of appendicitis, and that 
the nurse has been called in the night. While the sur¬ 
geon is making his examination of the patient the nurse 
should start a fire and put on the wash-boiler, to make 
sure of plenty of boiling water; she should then get six 
sheets and twelve towels, if possible. There may be no 
clean towels, and the nurse will have to wash some dirty 
ones. After being washed clean they can be placed in a 
tin pan, boiling water poured over, and allowed to re¬ 
main in the water a few minutes, when they are wrung 
out and placed in corrosive-sublimate solution (1 : 1000) 
until the surgeon is ready to use them. 

The kitchen should be rendered as clean as possible. 
The kitchen table should be prepared for the operating- 
table, and there should be procured two small tables for 
the instrument-tray and the sponges. If small tables 
cannot be had, chairs covered with a corrosive sheet or 
towels will do. If there is no gas-light, the nurse 
should get as many lamps as she can, and arrange them 
near the surgeon, but not too near the ether, be¬ 
cause ether is inflammable. The instruments are to 
be wrapped in a towel and boiled for ten minutes in a 
kettle of boiling water to which has been added two tea- 


152 


PRACTICAL POINTS IN NURSING. 


spoonsful of washing-soda to the pint of water, to prevent 
rusting. There must be left hanging out of the kettle one 
end of the towel, by which to lift out the instruments. 

After the surgeon has made the examination the part 
must be shaved, washed, and a corrosive towel applied; 
an enema should be given to clear the bowels, also a 
stimulating enema, and the urine should be drawn. 
While the patient is being etherized the nurse may 
arrange the tables and wash a flat bake- or meat-pan 
for the instruments. If sponges have been forgotten, a 
clean sheet can be torn up and folded into flat sponges. 
China basins can be used for the antiseptics, the sponges, 
and the surgeon’s hands; china pitchers for hot and cold 
water; a wash-tub for the soiled water; and hot bricks 
or beer-bottles for heaters. No matter how poor the 
family, the kitchen can be cleaned and prepared as an 
operating-room in a few minutes. Boiling water kills 
germs on contact, and where there are no means of 
sterilizing the sheets and towels, they can be soaked 
first in boiling water and afterward in corrosive-subli¬ 
mate solution (i : 1000). 

Anesthesia. — Ether .—A few words about the giving 
of ether, which duty may sometimes fall to the nurse, 
especially in emergency cases. Unless unavoidable, ether 
or chloroform must be never given on a full stomach, 
because the patient may vomit, and particles of food may 
lodge in the larynx and trachea and result in strangula¬ 
tion. The bladder and bowels must always be emptied, 
or they may act involuntarily. An ether cone is made 
by folding a newspaper, or a straw cuff may be shaped 
to fit over the nose and mouth, a stiff towel being folded 
around and secured with safety-pins, and a clean hand¬ 
kerchief or piece of cotton placed inside. 


THE PATIENT 


153 


Absolute silence must be maintained while the ether 
is being administered, as any conversation may be heard 
by the patient. Whatever is said by the patient when 
going under ether or coming out must be kept abso¬ 
lutely secret. Care must also be taken when the patient 
is coming out of ether that the operation is not dis¬ 
cussed. Many patients have been made miserable 
through carelessness on this point; for, while they could 
hear everything that was said by the nurses, they were 
totally unable to make any sign by which the nurses 
would know that they could hear. Death from ether is 
slow—by paralysis of the respiration—the signs of dan¬ 
ger being a blue and livid color of the skin, the respira¬ 
tions being low, shallow, and gasping. Ether affects 
people differently, and no definite rules can be laid 
down. Ether should be given slowly; in other words, 
the cone should not be filled with ether and put over 
the face, entirely smothering the patient. The nurse 
should show the patient how to inhale it, slowly and 
deeply, and also instruct the patient to close the eyes, 
because ether is an irritant to the eyes. About 2 tea- 
spoonsful of ether are poured into the cone, which the 
nurse should hold a little distance from the patient’s face, 
and as she becomes accustomed to the ether and under 
its influence the cone may be brought nearer; the stran¬ 
gling sensation of which so many patients complain is 
then in a measure avoided. Ether generally first pro¬ 
duces choking and coughing, followed by excitement; 
this is followed by the muscles becoming rigid, the face 
blue, and the breathing stertorous or snoring; this stage 
passes away, the muscles become relaxed, and the patient 
is in a state of insensibility. 

The lower jaw must be kept forward by placing the 


154 PRACTICAL POINTS IN NURSING. 

thumbs behind the angles of the jaw. Pushing the jaw 
forward and upward, which brings the upper behind the 
under teeth, prevents the tongue slipping back and ob¬ 
structing the larynx, and gives free access of air to the 

lungs (Fig. 38). Should 
the tongue slip back, it 
may be pulled forward 
with the fingers or with 
a pair of forceps. Fre¬ 
quent inspirations of 
fresh air should be 
given. When com¬ 
pletely etherized only 
a small quantity of the 
drug is needed to keep 
the patient under its influence. The mucus should be 
wiped from the patient’s mouth. The pupils should re¬ 
main contracted all through etherization, and dilate when 
the patient is coming out of ether. If the pupils are 
dilated during etherization, the patient is over-etherized, 
and they remain dilated until the muscles of the eyes 
regain their tone, when they contract. The sudden di¬ 
latation of the pupils is generally a sign of imminent 
death. It is very important for the nurse to watch 
carefully the respirations, because ether kills by suffoca¬ 
tion, the heart usually beating long after the respirations 
have ceased. The nurse should speak out if the pulse is 
growing rapid, feeble, irregular, or intermittent; if the 
respirations are becoming low, rapid, or gasping; if the 
face is becoming pale or blue, or the pupils are grad¬ 
ually dilating. 

If the patient seems inclined to vomit, the ether should 
be pushed, which will generally ward it off; should she 



Fig. 38.—Method of pushing the lower jaw 
forward to prevent obstruction to breathing. 





THE PATIENT. 


155 


vomit, her head should be turned to one side, to allow 
the matter more easily to escape from the mouth. One 
will see from the above that the giving of ether requires 
the undivided attention of the etherizer; no one can ether¬ 
ize and see the operation at the same time. Nausea and 
vomiting after ether may continue for two or three hours 
or longer. Should it persist until the following day, it 
may be due to shock or to some cause other than ether. 
Very hot water will often check vomiting, or crushed 
ice, black coffee, small doses of brandy, champagne and 
ice, or aromatic spirits of ammonia. Cocain, ^ grain 
every two hours for five doses, has been successful in 
severe cases ; also a mustard plaster over the stomach 
and the washing out of the stomach. Patients who take 
chloroform do not suffer from nausea so much as do 
those who take ether. 

In etherizing young children it is best to put them on 
the back and at once place the ether-cone over the mouth 
and nose without temporizing. If their pleadings to have 
the cone taken away are listened to—and they are hard 
to resist—their agony will only be prolonged and the 
operation delayed. Children are quickly etherized, and 
very rapidly recover from the influence of the ether. 

Chloroform is similar in its action to that of ether; it is 
pleasanter to take, and the patient is under its influence 
quicker, though it is more depressing on the heart than 
ether, and for this reason the patient is not allowed to 
rise until all effects have passed off. To give chloro¬ 
form, a few drops may be sprinkled on a handkerchief, 
a towel, or a small wire framework covered with flan¬ 
nel, or the drops may be sprinkled on a piece of absorb¬ 
ent cotton placed in a tumbler, which is held a little dis¬ 
tance from the patient’s face. The same symptoms are 


156 PRACTICAL POINTS IN NURSING. 

to be watched for as those in ether. Death from chlo¬ 
roform is almost always sudden, from paralysis of the 
heart : the pupils become dilated, the face becomes pale, 
and the pulse becomes flickering. 

Nurse’s Duties in Operating-room.—The duties of 
the nurse in the operating-room are the same for all 
operations. Her dress must be of cotton goods, the 
sleeves being made to roll up above the elbows. Both 
dress and apron must be fresh for the operation. 

On first going to the operating-room the hands and 
forearms of the nurse are to be thoroughly washed and 
scrubbed for ten minutes, and the finger-nails thor¬ 
oughly cleaned, thus removing the germs from the 
hands. The hands are then rendered absolutely sterile 
by putting them first into a saturated solution of per¬ 
manganate of potash until they are of a deep-brown 
color from the tips of the fingers to the elbow, then 
into a hot saturated solution of oxalic acid until all the 
permanganate stain has been removed; they are then 
washed in sterilized hot water, and finally are soaked for 
three minutes in a solution of corrosive sublimate (1 : 
500), which reaches the corners and crevices in the fin¬ 
ger-nails that cannot be reached by the brush. 

Some surgeons prefer ether and alcohol to cleanse the 
skin. After the hands have thoroughly been scrubbed 
in hot soap-suds and the finger-nails cleaned, the hands 
are washed in ether, which removes from the skin all 
oily and fatty substances; they are next washed in pure 
alcohol for one minute, and finally soaked for three min¬ 
utes in a solution of corrosive sublimate (1 : 1000). The 
patient’s skin is cleansed in the same manner with ether, 
alcohol, and the sublimate solution. 

The nurse next puts on a sterilized gown. If there 


THE PATIENT. 


157 


are no gowns—as in an emergency case, for instance— 
three sterilized sheets (see p. 15 1) will answer for gowns 
for surgeon, assistant, and nurse. The nurse now puts 
her hands again through the different solutions, and 
stands ready to get anything that may be called for. 

After making her hands aseptic the nurse should not 
touch her hair, her face, a door-knob, or anything that 
has not been made aseptic. If any article falls to the 
floor, it must not be picked up unless it is an instrument 
that the surgeon will need; then it must be boiled in a 
small pan which should be in the room in case this acci¬ 
dent happens. If a sponge falls, the nurse should move 
it with her foot to a position where it can be seen. The 
assistant will always tell a nurse when he wants fresh 
water for sponges; on no account must she take the pail 
without his knowledge. If she is asked to do anything 
that she does not understand, she should so inform the 
surgeon, who will always be perfectly willing to make 
the duty clear. 

The pails, bowls, and pitchers, and the tray for instru¬ 
ments must be washed inside and out, and filled with 
sterilized hot water, which is conveyed from the boiler to 
the pail by means of a perfectly clean pitcher or a tin 
ladle. The pads and rubbers to be used, also the ope¬ 
rating-table (the patient is generally etherized in bed), 
must be thoroughly washed with the corrosive-sublimate 
solution (1 : 1000). 

If the nurse is to wash the sponges, she should first 
make her hands aseptic, then count the sponges as she 
puts them into the pail of water, the surgeon counting 
them at the same time. She must be on the alert in 
case a fresh sponge or a sponge of a certain size is sud¬ 
denly called for; she should then take the soiled sponge 


153 


PRACTICAL POINTS IN NURSING. 


from the surgeon with her left hand and give him the 
fresh sponge with her right. She should not, while wait¬ 
ing to hand a fresh sponge, rest her hands or forearms on 
the pail; and if she has to stop to get something for the 
surgeon or to get fresh water, her hands must again be 
washed in the antiseptics before touching the sponges. 
If she is to sponge the wound, she should wipe swiftly 
and firmly. She should count the sponges before the 
surgeon begins to sew up the wound, and should be 
very sure that she has the exact number employed in 
the operation. 

Arranging- the Patient for Operation.—When the 
patient is brought into the operating-room and placed on 
the table, the clothes must be removed from the part to 
be operated upon, to prevent their getting soiled. If the 
part to be operated upon is the head or the chest, the 
night-gown must be pushed well down under the shoul¬ 
ders ; if it is a breast, an arm, or a leg, the gown should 
be opened down the front and be pushed to the opposite 
side; if it is the abdomen, the gown and under-vest 
must be brought well up under the shoulders and the 
under-vest be turned up so as to hold the arms in posi¬ 
tion across the chest. 

Sterilized blankets are tucked about the chest and the 
feet, the bandage and pad are removed from the part, 
and the latter is again thoroughly cleansed with soap 
and water and disinfectants. Sterilized sheets and towels 
are then arranged about the part. A table for the in¬ 
strument-tray is placed at the surgeon’s right side, also 
a chair or table on which is placed a pail or bowl of 
water for his hands. A table for the pails or bowls for 
sponges is placed at the opposite side of the table, at the 
assistant’s right hand, and the operation is begun. 


THE PATIENT. 


159 


After-care of Patient.—Just before the wound is 
closed the soiled towels are removed and replaced by 
fresh ones. After the dressing has been applied the 
patient is raised, wiped perfectly dry, a bandage put on, 
and is then carried to the bed, which has previously been 
prepared and heated with heaters well covered to pre¬ 
vent burning the patient. A towel should be placed 
under the chin of the patient in case she should vomit, 
and a small basin should be at hand, but not where she 
can see it on first returning to consciousness. The pa¬ 
tient should not be left until she is well out of the ether. 
If there is a member of the family not afraid of the sight 
of blood, the nurse may ask her to assist in cleaning up 
the room. 

Sequelse of Operation.— Shock .—After an operation 
the nurse must watch for two things—shock and hemor¬ 
rhage. Shock is great depression of the vital organs of 
the body produced through the nervous system, brought 
on by injury or surgical operation. The greater the in¬ 
jury and the longer the anesthesia, the greater the shock. 
The nearer the operation is to the trunk, the greater the 
shock. An operation on the abdomen or the amputation 
of a thigh is more severe and the shock is greater than 
operations on remote parts—a finger or a toe, for in¬ 
stance—because they are farther away from the heart 
and the nerve-centres. 

Mental shocks, such as sudden joy, grief, or fright, 
may be as severe as those of the body. Age modifies 
shock. In old people shock is usually more severe and 
prolonged, especially if there is any organic disease. 
Children recover readily from shock if there has been 
veiy little loss of blood. Invalids and individuals used 
to suffering stand shock better than those whose nervous 


i6o 


PRACTICAL POINTS IN NURSING. 


system is in a high degree of activity. Shock is modi¬ 
fied by mental conditions; it is aggravated by fear, de¬ 
spondency, or depressed mental conditions of any kind, 
while it is diminished by cheerfulness, hope, joy, etc. 

Two very important points to be remembered in case 
of shock and of hemorrhage are the temperature and 
the condition of the patient’s mind. In shock the tem¬ 
perature at first is normal or very little below normal, 
and the senses are dull in proportion to the degree of 
shock present; in hemorrhage the temperature is sub¬ 
normal and the mind is bright, keen, alert, and there is 
an anxious expression on the face, anticipating danger. 

The symptoms of shock are a weak, rapid, and irregu¬ 
lar pulse; sighing; rapid, irregular, shallow respiration; 
temperature normal or very little below; pale face with 
a pinched look; cold, clammy skin; the mind dull. 
There may be involuntary movements of the bowels and 
urine through loss of muscular power; nausea and 
vomiting. 

The treatment of shock consists in lowering the patient’s 
head and elevating the arms and the foot of the bed, to 
promote the supply of blood to the vital centres; in ap¬ 
plying heat to all parts of the body—the sides, between 
the legs, and to the feet—and a mustard plaster over the 
heart; in administering stimulants of whisky, brandy, or 
pure alcohol hypodermatically; in giving hot coffee or 
salt-solution by the rectum and very high up. An enema 
of ^ ounce of turpentine, a raw egg well beaten up, and 
3 ounces of warm water is a powerful stimulant. 

It must be remembered that in severe shock the func¬ 
tion of absorption of the stomach and intestines is almost 
wholly suspended, and anything given by the rectum 
must be given very high up. When the respiration of 


THE PATIENT. 


161 


the patient is fast failing, everything depends on main¬ 
taining the heart’s action. To this end artificial respira¬ 
tion must be persistently practised. When the depres¬ 
sion is deepened by hemorrhage, transfusion must be 
resorted to. External heat is the most powerful of all 
heart-stimulants, and often when the heart’s action 
threatens to fail it may be restored by heat over the 
heart and by hot fluids taken into the stomach. 

Strychnia is a powerful heart-stimulant, and, if at hand, 

grain should be given every half hour for four doses. 
Tincture of digitalis in 15-minim doses may be given 
every half hour for four doses. Ether alone, or mixed 
with an equal part of alcohol, has a more rapid stimulant 
action than alcohol. Recovery may be rapid or very 
slow ; then we get what is called “ reaction ”—the pulse 
becomes more full, slow, and regular, the temperature 
rises, the body becomes warm, and a general improve¬ 
ment takes place. 

Collapse is an extreme degree of shock, and almost 
invariably ends in death. 

Hemorvhage may be caused by the slipping of a liga¬ 
ture or the displacement of clots, due either to restless¬ 
ness or to reaction of the circulation, and it generally 
occurs within the first twenty-four hours after the 
operation. 

The symptoms of internal hemorrhage are restlessness, 
thirst, faintness, an anxious expression, pale face, cold 
skin, frequent and irregular respiration, subnormal tem¬ 
perature, and a weak, rapid pulse (120-140), though 
there have been cases of internal hemorrhage in which 
the pulse has not gone above 94 beats to the minute, all 
the other symptoms being very marked. 

11 


162 PRACTICAL POINTS IN NURSING. 

Treatment of Hemorrhage .—The two things to be 
remembered in the treatment of hemorrhage are position 
and pressure. The part from which the blood is coming 
should be elevated and the patient’s head lowered, to pro¬ 
mote the supply of blood to the vital centres. If the 
nurse can apply pressure by putting her finger on the 
artery, she should do so, or she may plug the wound 
tightly with sterilized gauze or a compress, and hold 
it there until the arrival of the surgeon, who must im¬ 
mediately be summoned. The patient is to be kept 
perfectly quiet on her back. If symptoms of shock 
supervene, heat is to be applied to all parts of the 
body by warm blankets and hot-water bottles. Stimu¬ 
lants are to be given only if the pulse is failing. When 
the hemorrhage has been excessive, transfusion is often 
resorted to, the fluid that the body has lost being thus 
replaced. 

Transfusion is the injecting of blood from the vein of 
one person into that of another or the injecting of a 
saline liquid, for the purpose of replacing the blood lost 
by hemorrhage. The most common normal saline solu¬ 
tion used is salt-solution, which consists of i^- teaspoons- 
ful of common salt to I quart of boiled water. The 
amount of solution injected varies from 8 ounces to a 
pint. The parts used for injection are the chest, the 
abdomen, the thigh, or the arm. For transfusion there 
will be needed an irrigator which has been thoroughly 
sterilized with boiling water and corrosive sublimate 
(i : 1000), followed by the boiling water, or a rubber 
tube and a glass funnel. The needle used resembles a 
hypodermatic needle, but is much larger. It must be 
boiled for several minutes, and fastened to the end of the 


THE PATIENT. 


i6 3 


rubber tube connected with the irrigator. The tempera¬ 
ture of the solution should be about ioo° F., and the 
solution must be strained through gauze or cotton when 
being poured into the irrigator. The part is washed with 
carbolic-acid solution (i : 20) before the needle is inserted. 

After-treatment of Patient.— Rest. —The after-treat¬ 
ment of every surgical operation consists in perfect rest 
of the patient on the back for a certain length of time, to 
prevent the ligatures giving way and to prevent irritation 
of the stomach and vomiting. 

The diet following operations is liquid until after the 
third day and the bowels have moved; then a light diet 
is given, such as cream toast, a soft-boiled egg, custard, 
buttered bread with the crust removed, cocoa, etc.; solid 
diet is afterward gradually resumed. 

After-treatment in Amputations. —After the amputation 
of a thigh the stump must slightly be elevated on a pil¬ 
low and a cradle be used to keep off the weight of the 
bed-clothes. A careful watch should be kept for hemor¬ 
rhage. When a breast has been amputated, the arm is 
confined to the side by a bandage. The arm will become 
very tired; this tired feeling can be relieved by putting 
under the arm a small pillow, upon which it can rest. 

After-treatment in Abdominal Operations. —After ab¬ 
dominal operations the patient cannot have anything by 
mouth for a certain number of hours. The extreme 
thirst can greatly be relieved by frequent bathing of the 
hands and face with alcohol and tepid water or with 
water alone. After operations on the abdomen it is well 
to place a roll under the knees. This roll will relax the 
abdominal muscles, and also remove the strain the patient 
would have to make to keep up the knees. 


164 


PRACTICAL POINTS IN NURSING. 


The external genitals are to be kept perfectly clean, 
the body is to be bathed, the bed and body-linen are to 
be kept sweet and clean, the teeth are to be brushed, and 
the hair is to be combed after the third day. Every 
want of the patient should be anticipated, and she should 
be made as comfortable and happy as possible. No 
visitors are to be admitted without the surgeon’s consent. 
The mind of the patient is to be kept perfectly free from 
worry and excitement, and the whole atmosphere of the 
room should be bright, pleasant, and cheerful, no matter 
what trouble is going on outside. The nurse must not 
allow the patient to sit up until two weeks after the ope¬ 
ration, as there is danger of a clot (thrombus) forming in 
a vein and being carried by the circulation to the pul¬ 
monary artery, causing sudden death. 

Bladder and Bozvcls .—The catheter should be passed 
every six or eight hours if necessary, according to direc¬ 
tions. The passage of gas by the rectum is a very good 
sign, as it shows that the bowels have regained their 
normal tone and that there is no obstruction. 

Drainage-tube .—If a drainage-tube is in the abdomen 
and the care of it is left to the nurse, she must each time 
before draining thoroughly scrub and sterilize her hands. 
The syringe must be washed first with boiling water, the 
water being passed through it several times, then with 
corrosive-sublimate solution (1 : 1000), followed with boil- 
ingwater; the syringe is then to be laid in the corrosive 
solution until the nurse has washed her hands a second 
time and unpinned the dressing covering the tube. The 
rubber tube attached to the syringe is passed down 
the centre of the drainage-tube to the bottom, then with¬ 
drawn a little, so that only the fluid will be drawn up, 
and not the tissues of the pelvis. The syringe piston is 


THE PATIENT. 


165 

to be slowly and steadily drawn up. When removing 
the syringe the nurse should be careful that the blood 
does not drop on the dressing. The mouth of the tube 
is to be covered while the syringe is being emptied,, and 
the corrosive and hot water are to be passed through the 
syringe before again putting it down the tube. 

Some surgeons prefer gauze drainage , a piece of twisted 
gauze being put into the tube, that sucks up the fluid. 
This gauze is changed at stated intervals, and the tube 
is cleaned with a small piece of sterilized cotton or gauze 
fastened on the end of a pair of long fine forceps ; then a 
fresh twist of gauze is inserted. With both these meth¬ 
ods the amount of fluid drawn and its character must be 
reported. When the drainage-tube is to be removed, 
the nurse should observe the same precautions as she 
would for a dressing. 

Hysterectomy .—The after-care of a hysterectomy, which 
is the complete removal of the womb and ovaries, either 
through the vagina (vaginal hysterectomy) or through 
the abdomen (abdominal hysterectomy), is the same as 
after any abdominal operation. Regarding the question 
of the mild form of insanity which may follow a hyster¬ 
ectomy or the removal of a large fibroid tumor, one 
must know that a large amount of blood is taken from 
the body, and that the cutting and tying of the large 
blood-vessels alters the circulation; the operation is also 
more or less a shock to the nervous system, and may 
affect the brain. Insanity is not a complication of this 
operation, the recovery from which is usually rapid; but 
when insanity does set in, this is commonly the cause, 
and the patient generally recovers. 

Septicemia .— Septicemia is blood-poisoning caused by 
the entrance of germs into the body through the agency 


166 PRACTICAL POINTS IN NURSING. 

of unclean hands (especially dirty finger-nails), instru¬ 
ments, sponges, towels, dressings, or the passing of a 
dirty catheter into the bladder, or in not washing the 
parts before catheterization. When septicemia occurs, it 
is generally the surgeon or attendants who must be 
blamed. In a very large majority of surgical cases the 
patient is in a healthy condition, and by a conscientious 
preparation of the patient for the operation, be it ever so 
simple, and of the room and of everything that will be 
used, the patient should and does make a good recovery. 
Should a healthy patient die of sepsis, then some one is 
always to blame; the germ was introduced by some one. 
Death may be due to some cause such as heart-disease, 
over which the surgeon has no control, the patient being 
willing to take the risk when consenting to the operation. 

Septicemia, or septic peritonitis, may occur any time, 
from a few hours to six days after the operation. The 
temperature is about 100° F., and the pulse rises rapidly 
to 115, 120, or 130 beats per minute, and is weak and 
thready; then the temperature rises to 103° F. or above, 
or it may range between ioo° and ioi ° F. until just 
before death, when it has been known to rise to 108° F. 
The abdomen is distended with gas; vomiting occurs 
(the ejected matter having a dark-brown color resem¬ 
bling coffee-grounds and a characteristic fecal odor); a 
cold perspiration appears : the patient has a very anxious 
expression and is restless and talkative; the eyes are un¬ 
usually bright. 

Treatment of Septicemia .—The nurse should send at 
once for the surgeon, and in the mean time try to move 
the patient’s bowels with high enemata of turpentine, 
glycerin, oil, salts, melted vaselin, butter, lard, or mo¬ 
lasses, or soap and water if there is nothing else at hand 


167 


THE PATIENT. 

The enemata should be given every two hours until 
the bowels are thoroughly moved or large quantities of 
gas are passed, because it is only by putting the bowels 
into an active state that one can overcome threatened 
paralysis of the intestines, and enable them to take up 
from the peritoneal cavity whatever blood-serum may be 
there. Stimulating enemata of whisky 1 ounce and warm 
water 2 ounces should be given every hour and a half. 
Brandy should not be used, because it is constipating. 
Strychnia, being a powerful heart-stimulant, is given in 
doses of grain every hour until its physiological effects 
are produced. It must be stopped at the first appearance 
of twitching of the muscles of the face or of the limbs, and 
stiffness of the neck. Vomiting may be relieved by wash¬ 
ing out the stomach or by the application of a mustard 
plaster over the stomach. If after repeated efforts the 
bowels are not moved by the third day, the result is 
usually fatal. All the symptoms deepen. The surface of 
the body is cold and clammy; the face is pinched and 
sunken and has a dusky hue; the restlessness increases, 
also the thirst, which is very great, and to the last the 
patient calls for water, which is vomited immediately after 
being taken, but which it is cruel to withhold. The mind 
is usually clear to the end. 

Surgical Disinfection and Materials. —Antisepsis and 
Asepsis.—Antiseptics prevent the growth of germs and 
putrefaction ; a disinfectant destroys germs; and a de¬ 
odorant destroys bad odors. Although an antiseptic 
may be a disinfectant and probably a deodorant, it does 
not follow that because a deodorant will destroy bad 
odors it will also kill germs. The best deodorant is 
pure, fresh air and sunlight; next, carbolic acid (which 
is both a disinfectant and a deodorant), charcoal, or lime. 


168 PRACTICAL POINTS IN NURSING. 

Asepsis , or sterility, means freedom from septic germs. 
For instance, before an operation the hands and fore¬ 
arms are scrubbed with nail-brush, soap, and hot water 
to cleanse them and remove the germs; then the hands 
are entirely freed from germs by putting them in the 
different antiseptic solutions ordered by the surgeon, 
thus reaching the corners and crevices in the finger-nails 
and skin that the brush could not reach; in this way 
the hands and forearms are rendered thoroughly asep¬ 
tic. The sheets, blankets, towels, gowns, instruments, 
sponges, and dressings are subjected to dry or moist 
heat, according to the orders of the surgeon, for a cer¬ 
tain length of time. Everything to be used at the 
operation is made as thoroughly aseptic as possible, and 
only that which has been rendered aseptic must be 
touched by those assisting at the operation. 

Antiseptics .—Some of the commonest antiseptics in 
use are corrosive sublimate, carbolic acid, permanganate 
of potash, creolin, thymol, boric acid, lysol, alcohol, 
peroxid of hydrogen, iodoform, and dermatol. 

Corrosive sublimate and carbolic acid are the best dis¬ 
infectants and antiseptics, but the corrosive cannot be 
used for the instruments or the clothing, on account of 
its discoloring properties; it is used in solutions of from 
i : 500 to 1 : 10,000. 

Carbolic acid does not discolor clothing or instru¬ 
ments, it having this advantage over corrosive sublimate, 
but it irritates and benumbs the hands. The strengths 
of the solutions used are from 1 : 20 to 1 : 80. The acid 
is bought in the liquid form, having a strength of 95 
per cent. To make a solution of 1 : 20, 1 :40, 1 : 60, or 
1 : 80, 1 ounce of the 95 per cent, solution is added to 
20, 40, 60, or 80 ounces of water. 


THE PATIENT. 


169 


Both corrosive sublimate and carbolic acid are very 
poisonous ; for this reason many surgeons have the parts 
washed with plain water after using these antiseptics, to 
prevent absorption. Symptoms of poisoning have been 

produced by the absorption of these drugs from surgical 
dressings. 

The first evidences of carbolic-acid poisoning are a 
very dark coloration of the urine, giddiness, ringing or 
singing in the ears, headache, and lassitude. 

The first symptoms of mercurial poisoning (corrosive 
sublimate) are fetid breath, excessive salivation, a metal¬ 
lic taste in the mouth, swollen and spongy gums, with a 
dark line at their upper margin, loosened teeth, and 
swollen tongue. If the use of these drugs is persisted 
in, all these symptoms deepen. On the appearance of 
any of these symptoms the dressing should be removed. 

Creolin is not so poisonous as the two above-named 
drugs, but it cannot be used for instruments, because 
of its yellow color, which prevents their being seen at 
the bottom of the tray. For cleansing the hands or 
other parts a 5 per cent, solution is used. To make a 
2 per cent, solution 2 \ teaspoonsful of creolin are added 
to 1 pint of water. 

Boric acid is an unirritating and non-poisonous anti¬ 
septic ; a 4 per cent, solution is generally used. 

Lysol as an antiseptic is much objected to by some 
surgeons on account of its soapy properties. When 
used for instruments it makes them slippery. The 
strongest solution used is 2 per cent. 

Permanganate of potash is an antiseptic used to 
cleanse the hands and other parts before operation, fol¬ 
lowed by a solution of oxalic acid to remove the stain. 
The permanganate stains everything with which it comes 


170 


PRACTICAL POINTS IN NURSING. 


in contact; it also causes pain and burns if used in very 
strong solutions. The strength of the solution gen¬ 
erally used is from 20 to 60 grains of the crystals to the 
pint of warm water. 

Oxalic acid will remove permanganate stain from the 
skin. This method is very irritating to the skin, but the 
irritation can in a measure be avoided by immersing the 
hands and forearms afterward in lime-water. Oxalic 
acid also removes permanganate stain from white goods, 
and hydrate of ammonia will remove the stain from 
black goods. 

Condy's fluid, which contains 16 grains of perman- 
ganate-of-potash crystals to 1 ounce of water, is both a 
disinfectant and a deodorant. 

Iodoform is an antiseptic that may be absorbed into 
the system if applied to raw surfaces and cause iodoform 
poisoning. The symptoms of absorption are headache 
and loss of appetite, followed by rise of temperature, 
rapid and feeble pulse, and restlessness; a bright-red 
eruption appears on the face and limbs, and there may 
be retention of urine. 

Peroxid of hydrogen, which is the most expensive anti¬ 
septic now in use, destroys the germs of pus. When 
poured into a wound an effervescence takes place which 
ceases only when the wound is rendered sterile, and 
which carries off any shreds of tissue in the wound that 
cannot easily be reached. It is also applied to the throat 
in diphtheria to destroy and remove the false membrane. 
Peroxid readily decomposes by coming in contact with 
metals. If used as a spray, a glass atomizer must be 
employed; the bottle must not be kept in a bright light, 
nor should the mouth of the bottle remain unstoppered 
any longer than necessary. 


THE PATIENT 


171 


Absolute alcohol is an antiseptic used for cleansing the 
skin ; it is also used for sterilizing silk, catgut, and silk¬ 
worm-gut sutures and ligatures. 

The best disinfectant is heat—either dry heat (baking) 
or moist heat (steam). Water of a temperature of 212° F. 
will kill germs on contact. 

Suturing.—Sutures, which are used to bring the edges 
of a wound together, are of silver wire, silk, catgut, or 


Fig. 39. —Interrupted suture (Bernard Fig. 40. —Continued or glover’s suture 

(Bernard and Huette). 

silkworm gut. The interrupted 
suture (Fig. 39) is made by pass¬ 
ing catgut or silk through the 
skin from one side of the wound 
to the other; then both ends are 
drawn together and tied in a 
double knot. The continuous 
suture (Fig. 40) is the ordinary over-and-over stitch from 
one end of the wound to the other. The button suture 
(Fig. 41) is made by passing wire across the bottom of 
the wound, bringing out the ends about 1 inch from the 
edge of the wound, and securing each end with a button. 

Ligation. —Ligatures, which are used for tying large 
blood-vessels, are of heavy twisted silk, silver wire, silk¬ 
worm gut, or catgut. 

Sterilizing Sutures. —The catgut is soaked for twelve 
hours in corrosive-sublimate solution (1 : 1000), and after- 
' ward, for twenty-four to forty-eight hours, in oil of juniper. 


and Huette). 



Fig. 41. —Button-suture (Bryant). 









172 


PRACTICAL POINTS IN NURSING. 


The spools are then transferred to covered glass jars con¬ 
taining sufficient absolute alcohol to completely cover the 
catgut. The alcohol is changed every two weeks. 

Gauze Sponges. —The sponges most commonly used 
are gauze pads, the cut edges being folded over and 
loosely hemmed, and little gauze bags, made by wrap¬ 
ping cotton waste in squares of gauze, the corners being 
brought together and stitched firmly at the top. Gauze 
sponges are never employed more than once. Those 
used in operations are afterward destroyed; those not 
used are re-sterilized, placed in sterilized towels, and de¬ 
posited in covered glass jars which are not uncovered 
until called for at an operation. 

In these days of antiseptic surgery the surgeon gen¬ 
erally attends to the preparation of the sutures, ligatures, 
and sponges: when this duty is left to the nurse it is a 
clear proof that the surgeon has great confidence in her, 
for septic material may as readily be conveyed into the 
wound by dirty sponges, sutures, and ligatures as by 
the hands, instruments, and dressings. 


IV. ACCIDENTS AND EMERGENCIES. 

1. Surgical Accidents. 

Fractures.—A fracture is the breaking of a bone into 
two or more pieces. A simple fracture is a single break 
without injury to the flesh. A compo 7 ind fracture is a 
single break with injury to the flesh. A fracture is said 
to be comminuted when the bone is broken into several 
pieces. An impacted fracture is one in which one frag¬ 
ment is driven and fixed into another. A green-stick 
fracture is one in which the bone is bent and partially 
broken. It occurs chiefly in young children. 



ACCIDENTS AND EMERGENCIES. 


173 


A fracture is said to be complicated when there is 
other injury, such as a lung punctured from a broken 
rib, or a nerve or a blood-vessel is injured, or when other 
bones or joints are injured. Fractures are also trans¬ 
verse, longitudinal, or oblique. 

Signs of a Fracture .—The signs of a fracture are 
loss of power, pain, swelling, crepitus (which is the 
grating made by the rubbing of the ends of the broken 
bone together, and which may be both heard and felt), 
distortion, and deformity. 

Bone-repair .—The repair of a broken bone is very 
interesting. At first blood is poured out around the 
ends of the broken bone and surrounding tissues. This 
blood gradually becomes infiltrated with lime and thick¬ 
ens to the consistency of jelly, which is then called “ cal¬ 
lus.” The callus cements and unites the broken ends 
of the bone, and by the deposit of new bone-forming 
cells gradually hardens and eventually becomes bone. 
The union takes about six weeks, though it is about 
nine months before being thoroughly complete. 

Management of Fractures .—The management of a 
broken bone until the arrival of a surgeon consists in 
securing perfect rest. If a leg be broken, the patient 
should be laid on a stretcher, a door, or a shutter; a 
splint may be improvised with an umbrella, a walking- 
stick, a thin board, books, newspapers, or a coat rolled 
up and tied to the side of the leg with handkerchiefs 
above and below the seat of fracture. If none of these 
articles are at hand, then both legs may be tied together. 
The patient’s clothes must be removed from the sound 
side first. The clothes should not be torn, but should 
be opened at the seams, which can easily be sewed up 
again. To remove the boots, one hand should be 


174 


PRACTICAL POINTS IN NURSING. 


placed at the ankle to steady the limb, and with the 
other hand the boot may be removed. If the foot is 
injured or if there is much pain, the seam of the boot 
must be cut open. Garters must be removed before the 
stockings, and the suspenders unfastened in front and 
behind before the trousers are removed. Work should 
be quiet and steady, as there is danger of converting a 
simple into a compound fracture through the broken 
ends of the bone running through the skin. If there is 
shock, heat is to be applied and stimulants given. 

The bed is to be made in the usual way, with a board 
underneath the mattress to prevent it sinking in the 
middle. A pillow should be placed around the limb 
and fastened with safety-pins, and a sand-bag should be 
placed on each side of the limb to keep it in position. 
Sand-bags are made of stout ticking, cotton, or any 
material that is sufficiently fine to prevent the sand from 
escaping into the bed. They should be long enough to 
extend from below the foot to above the knee, and be 
about 6 inches wide. The sand must be thoroughly 
dry, and the bags be filled about three parts full. The 
limb should be elevated on pillows; the toes must point 
upward. 

Before the arrival of the surgeon the nurse must get 
the part and the patient as clean as possible. She 
should have ready cotton or gauze bandages of different 
widths (from 3 to 6 inches); sheet-wadding bandages 
(about 4 inches wide), which, if a plaster-of-Paris band¬ 
age is applied, will be put on first to protect the skin ; 
sheet wadding; plenty of warm water; towels ; corro¬ 
sive-sublimate solution (1 : 1000) or carbolic-acid solu¬ 
tion (1 : 20); sheets to cover the surgeon and to protect 
the bed and the floor. If sheets cannot be had, news- 


ACCIDENTS AND EMERGENCIES. 175 

papers may be used for the bed and floor and a large 
apron for the surgeon. 

A patient with a broken leg is generally in bed from 
four to six weeks, and one with a broken thigh from 
eight to ten weeks. Bed-sores must not be allowed to 
form, and will not form if proper care be taken, unless 
the spine is broken or the nerve-supply is injured, in 
which case they will form even with the best of care. 

A broken arm after being dressed (Fig. 42) should be 
put in a wide sling (Fig. 43) made with a large handker- 



Fig. 42.—Splint for a fractured arm. 

chief folded diagonally, the ends tied around the neck, 
the point turned up above the elbow and fastened with 
safety-pins. 

For a broken jaiv the mouth should be closed firmly 
and bandaged with a folded handkerchief or a four-tailed 
bandage (Fig. 44). 



Fig. 43.—Handkerchief sling Fig. 44.—Four-tailed bandage 

for a broken arm. for the jaw. 


When the collar-bone is broken a pad of cotton should 
be put under the arm and the arm be bound across the 
chest. 













176 


PRACTICAL POINTS IN NURSING. 


Dislocations.— A dislocation is the displacement of the 
bone or bones of a joint by some external violence, such 
as a fall or a blow. A compound dislocation is one in 
which there is a wound connecting with the joint. The 
patient should be put to bed on his back, the part band¬ 
aged, and ice applied to prevent inflammation. 

Dislocation of the lower jaw , which is sometimes 
caused by yawning, can generally be overcome by the 
nurse wrapping her thumbs in a handkerchief and placing 
them in the patient’s mouth on the lower back teeth and 
pressing down and back, when the bone will generally 
slip into its place. 

Sprains.— A sprain is the wrenching of the ligaments 
of a joint; there may also be rupture of the fibres and 
blood-vessels. The limb should be placed first in mod¬ 
erately hot water, and the temperature gradually be raised 
until it is as hot as the patient can bear, the limb remain¬ 
ing in the water for about half an hour; or hot fomenta¬ 
tions may be applied and the limb be placed in a com¬ 
fortable position. 

Surgical Dressings.— Surgical dressings are divided 
into dry and moist; the latter is commonly called a 
“ water-dressing.” Ordinary cheese-cloth (prepared by 
being boiled for two hours in water to which has been 
added some washing-soda, after which the cloth is wrung 
out and washed in plain water to remove the soda, and 
again boiled for two hours in plain water, then taken out 
and dried), absorbent cotton, or the ordinary cotton¬ 
wool, pads of graduated compress, iodoform gauze, and 
permanganate gauze, are all used as dressings, though in 
an emergency old sheets, linen or cotton, cut to the de¬ 
sired size and sterilized in an oven, make very good ster¬ 
ilized dressings. 


ACCIDENTS AND EMERGENCIES. \yy 

For a water-dressing several thicknesses of gauze are 
wrung out of the ordered hot solution, applied over the 
part, and covered with two layers of sheet-cotton and a 
single piece of oil-silk or oil-paper, the whole being kept 
in place by a gauze bandage. 

A dry dressing consists in covering the wound with 
several thicknesses of sterilized gauze, over which is 
placed two or three layers of sheet-cotton, both dress¬ 
ings being secured by a bandage. Many surgeons first 
powder the wound with iodoform or a preparation of 
boric acid and iodoform or dermatol powder, to prevent 
irritation and chafing and to absorb the moisture. 

Tents are small strips of rolled gauze and are used to 
keep wounds open for the escape of pus. 

Management of Surgical Dressings. —Before beginning 
to do a surgical dressing the nurse should see that every¬ 
thing is ready. She should try to remember the favorite 
dressings for the different surgeons : this is sometimes 
rather difficult; still, after seeing a dressing done once 
she should, if quick and intelligent, know what will be 
needed the next time. Besides the dressings there will 
be needed a basin of warm corrosive-sublimate solution 
(i : iooo) for the hands, a basin of carbolic-acid solution 
(i : 20) for the instruments, towels, and a pail or a basin 
for the soiled dressings and discharges. If asked to pre¬ 
pare a wound for the surgeon’s inspection, the nurse 
must wash her hands with soap and water and corrosive- 
sublimate solution, having first covered any cut or scratch. 
She should then remove the bandage and dressing, which, 
if it adheres to the wound, may be wet with corrosive- 
sublimate or carbolic-acid solution, after which it will 
easily come off The nurse should wash toward , not 
away from, the wound, and cover it with a cloth wet in 
12 


i 7 8 


PRACTICAL POINTS IN NURSING. 


carbolic-acid solution until the surgeon is ready to 
inspect it. To remove a plaster begin at each end and 
work toward the wound. Putting one hand on the skin 
and pressing firmly down will prevent the peculiar tear¬ 
ing feeling of which a patient will complain. The marks 
of the plaster can be removed with alcohol, ether, tur¬ 
pentine, or soap and water, care being taken that the 
solution used does not enter the wound. 

Bandages.—Bandages are to retain dressings and 
splints in position, and also to apply pressure. Almost 
any kind of household muslin or gauze may be used for 
a bandage. Gauze is the best, on account of its elasti¬ 
city ; it can be applied to any irregular surface, and it 
is not necessary to reverse a gauze bandage. Shaker- 
flannel cut on the bias is used where greater strength is 
required and to make firm pressure. 

Rubber Bandage .—Rubber or elastic bandages are to 
prevent hemorrhage and to prevent or reduce swelling. 
The rubber bandage is put on from below upward, with¬ 
out reverses. It must not be drawn too tight nor be 
left on too long, or paralysis from pressure on the nerves 
of the part may result, or the circulation will be interfered 
with or entirely cut off. Rubber bandages should be 
rolled up quite loosely and be kept in a dark, moist 
place, or they become brittle and break into pieces. 

Roller-bandages. —Roller-bandages are from J inch to 
6 inches wide and from 2 to 8 yards long. The selvage 
must always be removed, the bandage rolled very tightly 
and evenly by hand or on a regular bandage-roller, and 
the loose threads of the edges trimmed off. 

In applying a bandage the nurse should hold the 
bandage in one hand, and, taking the loose end in the 
other hand, should so apply it to the part to be bandaged 


ACCIDENTS AND EMERGENCIES. 


179 


that the outer surface may be against the skin, and that 
the bandage will lie close to the limb (Fig. 46). All band¬ 
ages must lie smoothly and their pressure be uniform. A 



Fig. 45.—Bandaging an ankle. Fig. 46.—Bandaging a leg, showingmeth- 

od of reversing the bandage. 


bandage should always begin from the inner side of a 
limb, and thus bring the turns to its outer side (Fig. 45). 

A bandage must not be put on too tightly, as there is 
considerable danger of inflammation or of gangrene 
through the circulation being interfered with or being 
entirely cut off. It should fit snugly to the part, and an 
equal amount of pressure should be maintained. Inflam¬ 
mation and gangrene (death of a part) are often caused 
by tight bandaging. The fingers or the toes must be 
left exposed, so that one can see if the circulation is car¬ 
ried on all right. They should feel warm to the touch, 
and the color should disappear upon pressure and reap¬ 
pear when the pressure is removed. If they are cold, 
numb, swollen, or have a livid appearance, the bandage 
should be loosened. If in compound fracture the patient 
has pain, the pulse and temperature should be taken and 
the surgeon be notified. The bandage or dressing must 
not be removed unless the splints are pressing unevenly 
or displacement has occurred, or the fingers and toes are 
congested or swollen and there is danger of gangrene. 










i8o 


PRACTICAL POINTS IN NURSING. 


When taking off a bandage it should be rolled up 
loosely in the hand as it is unwound, thereby keeping it 
all together. 

The simplest forms of bandaging are the spiral and 
the figure-of-8 bandage. 

The spiral bandage consists in covering a limb by a 
series of spiral turns, each turn overlapping the one 
below for about one-third its width. In most limbs the 
enlargement at the upper part prevents the application 
of a spiral bandage without making a reversed turn in 
it. Without this turn only one edge of the bandage 
would come in contact with the part, the other would 
stand freely away from it. The reverses are made by 
placing a finger on the lower edge of the bandage to 
hold it firmly in position, and folding the bandage down¬ 
ward upon itself (Fig. 46). The turns should not be 
made over the prominence of a bone, and where possible 
should be made on the outer side of a limb. At the 
moment of making the turn the bandage should be held 
quite loose, and after the turn has been made it can be 



Fig. 47.—Figure-of-8 bandage. 



Fig. 48.—Bandaging a wrist. 


pulled as tight as necessary. In making the turn the 
hand should be held a little above the limb, and care be 
taken not to unroll more bandage than is necessary. 






ACCIDENTS AND EMERGENCIES. 


1 81 


The fignrc-of -8 bandage (Fig. 47) is the one most fre¬ 
quently used; it is easier to apply and it fits better. It is 
applied alternately above and below, each succeeding 
turn overlapping its neighbor by one-third its width. 
The figure-of-8 bandage needs very few reverses; still, 
they must be employed should occasion require them. 

The Desault bandage (Fig. 49) is applied in the treat¬ 
ment of fracture of the clavicle. 



Fig. 49.—Desault’s bandage : a, first roller ; b, second roller; c, third roller. 



Fig. 50.—Four-tailed bandage. 


Divided Bandages .—The four-tailed bandage (Fig. 
50) is useful for dress¬ 
ings about the face (Fig. 

44), the scalp (Fig. 58), 
and the knee. A many¬ 
tailed bandage (Fig. 51) 
is applied to a limb 
which requires frequent 
dressing, and consists of 
a piece of linen or muslin 
the length of the limb 

and wide enough to go Fio. 51.—Many-tailed bandage. 

one and a half times 

around. The muslin is torn from each side, in strips 
about 2 inches wide, to within about 3 inches of the 







































































182 


PRACTICAL POINTS IN NURSING. 


middle. The central part of this bandage is placed under 
the limb, and the tails are drawn to the front over the 
dressing and tied; beginning at the lowest pair, the ends 
are brought up and the next pair tied over them. 

The Scultetus bandage (Fig. 52) is used for bandaging 
the abdomen, and is made by taking two pieces of flan¬ 
nel or of cotton, each 1 yard long and 4 inches wide, 
the two pieces being placed 4 inches apart; across them 
are sewed five other pieces of the same length and width, 
each piece being overlapped by the one above it by one- 
half its breadth. This bandage is placed under the pa¬ 
tient’s back, the cross strips are folded over the abdomen 
from below upward, and the lower ends of the vertical 



strips are brought up between the thighs and pinned to 
the front of the bandage. This keeps the bandage from 
wrinkling and retains it in position. 

T -bandage .—The T-bandage (Fig. 53), which is to 
secure dressings on the anus or the perineum, is made 
of two strips of bandage, each about 5 inches wide. To 
the middle of one strip, which is to go around the waist, 
the end of the other strip is sewed, and is passed be- 







































ACCIDENTS AND EMERGENCIES. 183 

tween the thighs and fastened in front to the waist band¬ 
age with safety-pins. 

Handkerchief Bandages. — Handkerchief bandages 
(Figs- 54-58), which are very useful in emergencies, 



Fig. 54.—Handkerchief Fig. 55.—Three-cornered Fig. 56.—Four-cornered 

bandage for perineum and bandage for arm. bandage for arm. 

hip. 


consist of large handkerchiefs or of pieces of linen or 
muslin, each about 32 inches square. The triangle is 



Fig. 57 —Various forms of handkerchief bandages : a, for the chest : b, for the shoul 
der, hand, and arms ; c, double bandage to prevent motion of the arm. 


made by cutting the square diagonally, so that two 
three-cornered pieces is the result. A cravat is made by 
folding in the sharp corner toward the base of the tri¬ 
angle until a bandage about 3 inches wide is formed. 





















184 


PRACTICAL POINTS IN NURSING. 


Muslin cut in the form of a Maltese cross is used to 
apply a dressing snugly over an amputation-stump. 



Fig. 58.—Four-tailed bandage for the head. 


Plates 1 and 2 give a very good idea as to the 
various applications of roller-bandages. 

Plaster-of-Paris Bandage. —Plaster- of-Paris bandages, 
which are intended to prevent all motion in a part, are 
made by sprinkling gauze or cotton bandages with 
dentists’ plaster of Paris; these bandages are loosely 
rolled and kept in a covered jar or a tin box to ex¬ 
clude the air. 

When needed the rolled bandages are placed in warm 
water to which has been added a little salt, to help the 
plaster to set more rapidly; they remain in the water 
until the water-bubbles cease, when they are wrung out 
by holding the bandage at each end, thus preventing the 
plaster coming out at the sides, which happens if the 
bandage is taken in the hand and squeezed in the middle. 
A little plaster cream should be prepared, to be applied 
over the bandage after its application to fill up any crevices. 
The cream must be constantly stirred or it will gradually 
thicken and become hard. The limb is first enveloped 
in a thick layer of sheet wadding, then the prepared 
bandages, after having been thoroughly wet, are applied 
in the usual manner. After the bandage has been ap- 


BANDAGING. 


Plate i. 



i. Demi-gauntlet bandage; 2. Gauntlet bandage; 3. Spica of the thumb; 4. Spiral reverse 
bandage of the upper extremity; 5. Recurrent bandage of a stump; 6. Spiral reverse bandage of 
the lower extremity (from An American Text-Book 0/ Surgery). 






BANDAGING. 


Plate 2. 



1. Figure-of-8 bandage of the ankle; 2. Method of covering the heel; 3. Recurrent bandage of 
the head; 4. Crossed figure-of-8 bandage of both eyes; 5. Barton’s bandage, or figure-of-8 of the 
jaw; 6. Velpeau's bandage (from An American Text' Book 0/ Surgery), 



























•* 












*• * I'* - I • 
























ACC/DENTS AND EMERGENCIES . 


I8 5 


plied the dressed limb is exposed to the air until the 
bandage is dry and hard; after this the limb is placed 
between sand-bags, covered with the upper bed-sheet, 
and the weight of the blankets is supported by a cradle. 

Another method of making the plaster bandage is to 
shake the plaster into cold water until the mixture is of 
the consistency of cream; the plain muslin or gauze 
bandage is unrolled in a basin of water, re-rolled in the 
basin containing the plaster cream, and then applied; but 
this method is only resorted to when the powdered band¬ 
ages are not prepared. The cream must be constantly 
stirred or it will gradually thicken and become hard. 

If the bandage is applied to the upper part of the 
thigh, where it is likely (especially with children) to get 
wet with urine or soiled with fecal discharge, it may be 
kept clean by giving it a coat of varnish. 

Silicate-of-soda Bandage .—A silicate-of-soda dressing 
consists in protecting the limb as in the case of a plaster- 
of-Paris bandage, after which bandages saturated with 
silicate of soda are applied. Another way is to bandage 
the limb with muslin bandages and paint each layer with 
the silicate. From three to five layers of bandage are 
generally applied. The disadvantage of this dressing is 
that it takes too long for it to dry thoroughly; it is 
readily removed with water. 

Starch Bandage .—A starch bandage is made by mix¬ 
ing starch in the way it is ordinarily prepared for laundry 
purposes, applying a bandage over the limb, and painting 
the starch over the bandage; strips of pasteboard are 
soaked in the starch, laid along the limb for support, and 
another starch bandage is applied over the pasteboard. 

Chalk-and-gum Bandage .—A chalk-and-gum bandage 
is applied in the same way as the starch bandage. The 


186 PRACTICAL POINTS IN NURSING. 

mixture is prepared by taking equal parts of gum-arabic 
and precipitated chalk, and adding boiling water until 
the admixture becomes of the consistency of thick 
cream. This mixture dries more quickly than starch, 
which takes two or three days to dry, and the bandage 
is also stouter. The plaster-of-Paris bandage has the 
advantage over all other bandages in being more durable 
and in the rapidity with which it can be applied and with 
which it sets. 

Splints.—Splints are used to keep a broken bone in 
its proper position. A splint should fit above and below 
the seat of fracture, care being taken that it does not 
press upon any prominent part. There are a large 
variety of splints which are adapted for every part of the 
body, but perhaps the commonest are the coaptation 
splint, which can be adjusted to any part, and the plaster- 
of-Paris splint. 

Splints may be improvised with cardboard, gutta¬ 
percha, leather, felt, tin, wood, an old hat, a coat rolled 
up, an umbrella, a walking-stick, or newspapers. The 
cardboard, leather, or gutta-percha is first soaked in hot 
water, after which it will easily mould to the part; such 
splints are perforated to allow the escape of perspiration. 
They should be covered with a compress or with sheet 
wadding of three or four thicknesses, brought smoothly 
over the edges and stitched firmly or held in place with 
strips of adhesive plaster. 

Plaster-of-Paris Splint .—A plaster-of-Paris splint is 
made by taking flannel, linen, or muslin (folded to three 
or four thicknesses) to envelop the limb, and stitching 
through the middle of the folds after the manner of 
stitching the leaves of a book. The folded material is 
soaked in the plaster-of-Paris cream, laid on a board, 


ACCIDENTS AND EMERGENCIES. 


187 

opened out, and applied over the limb, which is first cov¬ 
ered with sheet wadding. Plaster of Paris must be kept 
covered, as it absorbs moisture from the air; if it is 
moist, it can be dried in the oven. 

This bandage is readily removed by making a line 
with a knife and dropping water along the line from a 
medicine-dropper or a spoon to soften the plaster, after 
which the bandage can be cut with scissors and removed. 

Extension.—Extension (Fig. 59) is used to prevent 
the shortening of a limb. To prevent the extension- 
apparatus gradually pulling the patient’s body to the 



foot of the bed, the foot of the bed must be raised on 
two blocks of wood (8 or 10 inches high), thus obtaining 
counter-extension by the weight of the patient’s body, 
everything being taken away from under the patient’s 
head except a small pillow. The materials required for 
extension are two strips of adhesive plaster 3 inches wide 
and long enough to reach from above the knee to below 
the foot, leaving a loop. A piece of wood (4 inches long 
and 1 inch thick), having a hole pierced through its cen¬ 
tre, is inserted in the loop beneath the foot and fastened 
in place. The adhesive-plaster strips are placed along 












188 


PRACTICAL POINTS IN NURSING. 


the sides of the leg to above the knee, and further se¬ 
cured by a bandage. One end of a stout cord is passed 
through the hole in the wood and knotted. The cord is 
carried over a pulley attached to the foot of the bed and 
fastened to a weight. Smoothing-irons, bricks, or sand¬ 
bags may be used as weights: these must first be 
weighed, so that the surgeon will know the number of 
pounds he is putting on. 

Wounds.—A wound is defined as a solution of con¬ 
tinuity of the tissues—a separation of the continuous 
parts by violence. There are different kinds of wounds 
—incised, contused, lacerated, punctured, gunshot, or 
poisoned. An incised wound is a cut made with a sharp 
instrument. Contused and lacerated wounds are made 
with a blunt instrument, the tissues being torn and 
bruised. A punctured wound is made with a pointed 
instrument, such as scissors, a nail, etc. Gunshot wounds 
are caused by firearms. A poisoned wound is caused by 
an agent which carries with it into the wound a poison. 
Wounds may also be aseptic or septic. An aseptic 
wound is one which is free from and is preserved from 
-all poisonous bacterial products. A septic wound is one 
in which the bacteria are present, they having gained 
access either through injury and exposure before treat¬ 
ment or during the treatment. 

Healing of Wounds. —Wounds heal by first intention 
or by second intention. Wounds heal by first intention, 
or primary union, when the edges are brought together 
and rapidly heal without granulation or suppuration. 
Wounds heal by second intention , or granulation, when 
the edges are separated and the wound is large and 
deep, and the granulations, which are soft, bright-red 
elevations, fill up the wound from the bottom and sides. 


ACCIDENTS AND EMERGENCIES. 


189 


Occasionally the granulations grow too rapidly and pro¬ 
ject above the surface of the skin. This condition is 
commonly called “ proud flesh,” which is removed either 
with nitrate of silver or with the knife. Granulations are 
sometimes pale and flabby and have to be stimulated. 
Occasionally a wound healing by granulation will heal 
from the top instead of from the bottom and sides. 
When this process of repair occurs the wound is kept 
open with gauze packing, a little of which is removed 
each day as the wound heals up from the bottom. Only 
an incised wound heals by first intention; other wounds 
heal by granulation. Healing under a blood-clot , of 
which we so often hear, occurs when an aseptic blood- 
clot remains in a sterile wound. The blood-clot grad¬ 
ually becomes organized and serves as a scaffolding for 
the new tissue which is thrown out from the surround¬ 
ing parts. When the wound heals the surface clot breaks 
up, is brought away with the dressings, and a firm scar 
is seen. If the wound has become infected, the clot may 
be swept away with the pus, and the wound then heals 
by granulation. Suppuration , which is the end of infect¬ 
ive inflammation, consists in the formation of pus, which, 
if absorbed into the system, will result in erysipelas or 
pyemia. Both these terms mean blood-poisoning; the 
former is septicemia without abscesses, the latter, septi¬ 
cemia with abscesses, and is the severer disease. 

Erysipelas .—Erysipelas is due to the entrance of germs 
into a wound either during or after an operation, and is 
generally caused by the instruments, the sponges, the 
dressings, or the hands not being properly sterilized. 
The symptoms are a chill, a rise of temperature, and 
swelling and pain : the skin around the wound is of a 
bright-red color, which disappears upon pressure. 


I90 PRACTICAL POINTS IN NURSING. 

Pyemia .—Pyemia is blood-poisoning together with the 
formation of abscesses. The symptoms are severe chill, 
followed by profuse perspiration, rise of temperature and 
pulse, nausea, vomiting, and diarrhea, and pain at the 
point where the abscess is forming. 

TJie treatment for both these diseases consists in iso¬ 
lating the patient, in sustaining the patient’s strength 
with nourishing food and stimulants, and in observing 
thorough asepsis. Each surgeon has his own method 
of treatment, and his directions must faithfully be carried 
out. 

Tetanus .—Tetanus is an infective disease which almost 
always originates from wounds, particularly those of the 
extremities. The infecting germ may enter a wound, 
large or small, at or a few days after the time of injury. 
The earliest symptom is stiffness of the neck, after which 
the muscles of the face and jaw become rigid, so that the 
patient cannot open his mouth. This condition is com¬ 
monly called “ lockjaw.” Gradually the other muscles 
are affected by spasms, which are very severe, and the 
face has a peculiar grinning expression. If the body is 
bent forward, the condition is called “ emprosthotonos 
if the head is stretched backward and the spine arched, 
it is called “ opisthotonos.” 

TJie treatment of tetanus consists in keeping the pa¬ 
tient perfectly quiet in a darkened room, care being taken 
to disturb him as little as possible. Nourishment, stimu¬ 
lants, and medicine may be given by the rectum if nec¬ 
essary. Morphia may be given subcutaneously. The 
bowels must be kept open, and retention of urine may 
be relieved by catheterization. The number of spasms 
must be counted and the degree of their severity be 
noted. The pulse is rapid and weak, and the temper- 


ACCIDENTS AND EMERGENCIES. 191 

ature is slightly elevated. The exhaustion is extreme, 
due to loss of food and sleep. An acute attack may 
result in death from asphyxia or exhaustion in from 
three to five days, the mind, as a rule, being clear to 
the end. 

Gangrene is the mortification or death of a part, pro¬ 
duced by the stoppage of the circulation in that part by 
cold or frost-bites; a severe form of inflammation in a 
weak part may also lead to gangrene. The germs de¬ 
stroy the vitality of the part, and spread until they meet 
with parts strong enough to resist their action; then a 
line of demarcation is formed. There are two forms of 
gangrene, moist and dry. 

Moist gangrene may be produced by an accident when 
the injury is extensive and the supply of arterial blood 
is cut off, or it may be caused by an obstruction to the 
return of venous blood. The symptoms are first pain and 
intense burning in the part; red skin-coloration which 
changes to a purple or a greenish-black; there is a fetid 
odor; the part is swollen and soft; the skin is raised in 
blisters; there is a watery discharge; and the line of 
demarcation marks the living from the dead part. 

Dry gangrene, or “senile gangrene,” as it is called, is 
due to an impaired condition of the circulation in parts 
at a distance from the heart, such as the toes, where the 
circulation is not very vigorous, or to a diseased condi¬ 
tion of the arteries. 

The symptoms are numbness and tingling in the part; 
the color of the skin gradually changes to a dark red, 
then to purple, and finally the part destroyed becomes 
black, dry, wrinkled, and resembles in appearance the 
limb of a mummy. When the progress of the disease 
is arrested a line of demarcation is formed. The de- 


192 


PRACTICAL POINTS IN NURSING. 


pressed and lowered condition of the patient must be 
met with stimulants and nourishing food, and thorough 
antisepsis be observed. 

Abscess.—An abscess is a collection of pus occurring 
in any of the tissues or organs of the body, and is one 
of the terminations of inflammation. It may be acute or 
chronic (cold), circumscribed or diffused. 

Boil.—A boil (furuncle) is a localized inflammation of 
the skin and subcutaneous tissues, frequently about a 
sebaceous gland, forming a small painful swelling with 
pus-formation and ending in the expulsion of a necrosed 
centre or “ core.” A blind boil is a non-suppurating swell¬ 
ing that gradually subsides, the contents being absorbed. 

Carbuncle.—A suppuration of the subcutaneous tis¬ 
sue, most generally situated under the thick skin at the 
back of the neck, is a carbuncle. It is distinguished 
from a boil by being larger and of longer duration, in 
having no central core, in having several points of sup¬ 
puration, in being less defined and prominent, but more 
extensive in its sloughing. 

The treatment is surgical, antiseptic dressing, and 
good nourishing food. 

Ulcer.—An ulcer is an open sore, attended by dis¬ 
charge, generally due to certain difficulties obstructing 
the healing process. 

Fistula.—A fistula is an abnormal opening between 
an internal part and the surface of the body, or between 
two organs of the body, such as the bladder and vagina 
or the vagina and rectum. 

The treatment is surgical; fresh air, good food, and 
tonics are essential. 

Sinus.—An opening upon the surface of the skin, 
ending in the cavity of an abscess, is a sinus. It is gen- 


ACCIDENTS AND EMERGENCIES. 


193 


erally caused by the failure of the abscess to heal, by the 
presence of a piece of dead bone, by inability of the walls 
of the cavity to come together, or by a diseased condi¬ 
tion of the walls of the cavity. 

2. Common Emergencies. 

Under this head will be considered the emergencies 
apt to be met with in every-day life. 

Hemorrhages.—It is impossible to be too thoroughly 
prepared to meet the emergency of hemorrhage, as the 
care and responsibility of the patient rest entirely upon 
the nurse until the arrival of the surgeon. 

Hemorrhage may be external or internal. The bleed¬ 
ing may come from the arteries, the veins, or the capil¬ 
laries. Arterial blood is bright red, and bursts out in 
spurts with each beat of the heart. Venous blood is 
dark; the stream is steady, flowing to the heart. Cap¬ 
illary blood is of an intermediate shade, and oozes. 
Capillary hemorrhage is dangerous only when a num¬ 
ber of capillaries give way at one time. 

Hemorrhage is also primary, recurrent (intermediate), 
or secondary. Primary hemorrhage is that which takes 
place when an incision is made. Recurrent or intermedi¬ 
ate hemorrhage is that which takes place during the first 
twenty-four or forty-eight hours after an operation, and 
which is due to the force of the circulation of the blood 
after reaction has set in, to the displacement of clots 
through restlessness, or to the slipping of a ligature. 
Secondary hemorrhage takes place between the first day 
and the complete healing of the wound, about the time 
the ligatures or sloughs separate. It is generally caused 
by diseases of the walls of the arteries, by a ligature not 
being strong enough or being tied too loosely, or by the 
13 


194 


PRACTICAL POINTS IN NURSING. 


too rapid absorption of a catgut ligature, or by sepsis, 
the germs eating their way through the walls of the 
blood-vessels, which become so thin that they cannot 
stand the force of the blood pumping through them, and 
finally burst. Children do not stand the loss of blood 
well, but they rapidly recover as a rule. Adults in 
health stand the loss of blood well; old people do not, 
neither do they quickly recover. 

Symptoms .—The symptoms of hemorrhage are rest¬ 
lessness, faintness, demand for air, weak and rapid pulse, 
subnormal temperature (96° or 97 0 F.), anxious expres¬ 
sion, pale face, cold extremities, feeble, sighing respira¬ 
tions, sometimes a mist over the eyes, and a roaring in 
the ears. 

Treatment .—The treatment of hemorrhage consists 
of position and pressure. The bleeding part should 
be elevated to promote the supply of blood to the 
vital centers; pressure may be applied with the finger 
on the artery, or the wound may be plugged with 
sterilized gauze or with a handkerchief; morphia (gr. J) 
may be given to secure rest and quiet, stimulate the 
heart, and contract the blood-vessels. The patient is to 
be kept perfectly quiet, to allow the blood to coagulate 
in the vessels, and plenty of fresh air should be given. 
Alcoholic stimulants must be given very cautiously, as 
they excite the heart’s action and increase the hemor¬ 
rhage ; hence they must not be given without orders 
from the surgeon, unless the pulse is very weak and in¬ 
dicates heart-failure. If hemorrhage should occur from 
the stump of a limb after the amputation, the nurse should 
elevate the part and make firm pressure with her finger 
on the artery until the surgeon arrives. 

Flexion , or the bending of a limb, is another way to 


ACCIDENTS AND EMERGENCIES. 


195 


stop hemorrhage. A pad of cotton is put in the joint— 
the hollow of the elbow, under the knee, or in the groin ; 
against this pad pressure will be made when the limb is 
bent. Ice and very hot water are also used in hemor¬ 
rhage, heat being the better, as it stimulates the blood¬ 
vessels and causes the blood to coagulate, while ice par¬ 
alyzes the vessels, stopping the hemorrhage for a while; 
but when the ice is removed and reaction from the cold 
sets in, and the circulation is restored, the blood-vessels 
dilate wider than before and the bleeding begins again. 
Moreover, with the application of ice, which is seldom 
clean, there is the danger, if it be put on a raw surface, 
of introducing germs into the system. Fainting has a 
tendency to check hemorrhage, as it permits the blood 
to coagulate. 

Venous hemorrhage is checked on the side of the 
wound that is away from the heart. The limb should 
be elevated slightly and pressure applied. 

A tourniquet made of a piece of compress or a knotted 
handkerchief tied and twisted with a stick, the knot or 
some round smooth object being over the artery (Fig. 

A 


Fig. 60.—Impromptu tourniquets for compressing an artery with a handkerchief and 

a stick. 

60, A and b) will stop the circulation to a part, but it 
cannot remain on longer than half an hour or the part 
may die. Position, pressure, and morphia are the best 









196 PRACTICAL POINTS IN NURSING. 

remedies for hemorrhage. The first two can always be 
had, and morphia sustains the heart’s action, secures rest 
and quiet, and contracts the blood-vessels. 

The other methods of stopping hemorrhage—tor¬ 
sion, ligation, cauterization, acupressure—belong to the 
surgeon. 

When much blood has been lost the patient suffers 
greatly with thirst, which is often extreme on account of 
the amount of fluid that has been taken from the body. 
For this reason there may be given to drink, in small 
quantities, cold water, which will relieve the thirst and 
also make up for the amount lost by resorption. The 
patient should be fed well and often and in small quan¬ 
tities. 

Bleeding from the palm of the hand may be controlled 
by clasping a clean handkerchief and holding the hand 
high above the head. 

Hemoptysis .—In hemorrhage from the lungs (hemopty¬ 
sis) the blood is bright red, and frothy from its admixture 
with air. In treating hemoptysis the head and shoulders 
are elevated and an ice-bag or an ice poultice is applied 
to the chest; crushed ice may be given the patient to 
swallow. Equal parts of vinegar or lemon-juice and 
water, given in teaspoonful doses, or a quarter of a tea¬ 
spoonful of dry salt, will contract the blood-vessels. 
Rest and quiet will be obtained by the administration of 
morphia (gr. |-), chloral (gr. x), or bromid of potassium 
(gr. xx). 

Hcmatemesis .—Bleeding from the stomach (hemateme- 
sis) is treated in the same way as that from the lungs. 
The blood in this case is vomited, is of a dark-red color, 
and contains particles of food. The feces are of a very 
dark color, through the blood having passed into the 


ACCIDENTS AND EMERGENCIES. 


19 7 


intestines. It is always well to examine the nose and 
throat, because the bleeding may not come from the 
stomach, but from the nose, the blood having passed 
down the throat into the stomach. 

Epistaxis .—For nosebleed (epistaxis) the head and arms 
should be elevated, and pressure with the fingers should 
be made on the nostril from which the blood is coming, 
or a small piece of lemon or a small piece of cotton 
wrung out of vinegar and inserted will contract the 
blood-vessels. The patient should not blow the nose, 
as it will disturb the formation of clots. Ice may be 
applied to the back of the neck and to the forehead. 

Burns and Scalds.—Burns and scalds are the same in 
effect. A burn is caused by dry heat—fire or heated 
metals; a scald is caused by moist heat—heated fluids 
or steam—and is apt to be extensive, because the fluid 
spreads over a larger surface than a burn; a burn, how¬ 
ever, is deeper. Burns are of three degrees : 

1. Inflammation without blisters, or destruction of the 
epidermis without penetrating the true skin. 

2. Inflammation of the skin resulting in the formation 
of blisters, the latter caused by an outpouring of the 
water of the blood, that lifts the outer skin from the 
true skin. 

4 

3. Partial or complete destruction of the nerves and 
blood-vessels of the part. Their vitality is destroyed. 

A burn of the first degree may result in death if two- 
thirds of the body is burned, because, although there is 
only a mere reddening of the skin, the action of the skin 
is lost, consequently the power of perspiration or excre¬ 
tion is lost; extra work is thus thrown upon the kid¬ 
neys, which become inflamed, and death may occur from 
nephritis, which is inflammation of the kidneys. 


198 PRACTICAL POINTS IN NURSING. 

Burns of the second degree may end fatally if exten¬ 
sive, because the superficial blood-vessels are destroyed; 
consequently, more blood is driven to the internal or¬ 
gans of the body, which become very much congested, 
and acute inflammation sets in, which may result in death. 
Death from burns of the second degree may occur from 
shock, exhaustion after long-continued suppuration, which 
follows the separation of the sloughs, also septicemia or 
tetanus (lockjaw). 

The result of a burn of the third degree is nearly 
always fatal in the old or the young, and is determined 
by the part affected and by the age and health of the 
patient. Burns of the abdomen, the head, and the chest 
are more severe than those of the extremities, because 
they are nearer the vital organs. 

Shock is always present in burns of the first degree, 
though not so great as in those of the second and third 
degree, and the reaction after shock may result in in¬ 
flammation of any of the vital organs. 

Pain is severe in slight burns, because the nerve-end¬ 
ings are exposed; it is less severe in deep burns in which 
there is total destruction of the part. 

Edema of the Glottis. —Edema, or dropsy of the glottis , 
is caused by the inhalation of steam or the drinking of 
scalding liquids. Edema is a pouring out of the wateiy 
part of the blood into the tissues, and the effusion may 
increase with great rapidity. Death by suffocation may 
occur within a very short time. The symptoms of edema 
are gradual loss of voice, difficulty in breathing, and 
blueness of the surface of the body (cyanosis) from in¬ 
sufficient oxidation of the blood, gasping respirations, 
and a flickering pulse. Tracheotomy or intubation is 
generally performed. There may be inflammation with- 


ACCIDENTS AND EMERGENCIES. 1 99 

out edema, and this may develop into bronchitis and 
pneumonia. 

The treatment of burns and scalds consists in first at¬ 
tending to the shock by the application of heat to the 
body, or, if possible, in giving a hot bath (temperature 
ioo° F.), the administration of stimulants (alcohol or 
black coffee), and the application of a mustard plaster 
over the heart. The clothing is to be removed gently, 
being cut if necessary. If the burn is slight and no blis¬ 
ters have formed, the part is to be dressed with a satu¬ 
rated solution of ordinary baking-soda or dusted with 
either baking-soda, flour, or starch, and the air excluded, 
because air is an irritant. If blisters have formed, they 
should be opened, the fluid being allowed to run on to a 
piece of cotton, and then dressed with either carbolic- 
acid solution (1:40), sodium-bicarbonate water, sweet 
oil, vaselin, zinc ointment, or Carron oil (equal parts of 
linseed oil and lime-water), and the air excluded. 

A raw surface should not be dusted with flour, starch, 
or any other powder, because these substances harden 
and form crusts, which are painful to remove. The 
dressing should be removed only when really necessary, 
on account of the extreme pain, and only one part at a 
time should be exposed and dressed. If the dressing 
adheres to the part, it should not be pulled off, but 
should be wet, so that it will come off without causing 
the patient much pain. The bed should be made up 
with old sheets and old pillow-cases. The patient’s 
strength should be maintained with a nutritious diet 
and stimulants, and the thirst relieved with crushed 
ice. The bowels should be kept open, and the nurse 
should watch for retention of urine. 

Complications of Burns and Scalds .—Some of the 


200 


PRACTICAL POINTS IN NURSING. 


complications are delirium, meningitis, ulceration of the 
duodenum (the first part of the small intestine near the 
stomach), which may result in perforation of the intes¬ 
tine and cause peritonitis, inflammation of the lungs and 
kidneys or intestines, and retention or suppression of 
urine. Great distortion or deformity is often caused by 
contraction of the healing skin. The scars are densely 
white. To prevent deformity, the parts are put in splints 
in the best possible position ; skin-grafting is often re¬ 
sorted to, and in some cases amputation is performed. 

Sunstroke.—The symptoms of sunstroke are a tem¬ 
perature of from 105 to 112 0 F., sometimes higher, a 
flushed face, stertorous breathing, and unconsciousness. 
The patient should be put into a cold bath and rubbed 
with ice. If at the seaside, he may be carried to the 
beach and put in the water; the head may be kept cold 
by bathing it, or by the application of handkerchiefs 
wrung out of the water. If a cold bath is impossible, 
the patient may be douched with cold water from a 
hose-pipe or from pails, and cold cloths be kept on the 
head. Enemata of ice-water are very good. The cold- 
water treatment must be continued until the temperature 
has fallen, after which the patient should be put to bed, 
and, if there is depression, be given stimulants moder¬ 
ately. Should the temperature begin to rise, the above 
treatment should be renewed. 

Heat-exhaustion.—Heat-exhaustion is caused by too 
long exposure to a very high temperature; the blood 
leaves the brain and the surface of the body, and goes 
to the large blood-vessels of the abdomen. The symp¬ 
toms are those of shock. The treatment is the same as 
that for shock : hot bath if possible, or heat applied to all 
parts of the body; stimulants of alcohol or strong coffee. 


ACCIDENTS AND EMERGENCIES. 


201 


Lightning-stroke.—For a lightning-stroke the treat¬ 
ment is the same as that for shock. 

Fainting.—The head of a person in a faint should be 
lowered and the feet raised, the blood being thus sent 
back to the brain. Plenty of air, the clothing loosened 
about the neck and chest, and a little cold water dashed 
over the face, are usually sufficient to restore conscious¬ 
ness. A method often practised is to place the patient 
on a chair, and to push the head down between the 
knees, the hands hanging down by the side. The pa¬ 
tient is kept in that position until the face becomes red, 
being then able to rise and walk about. This position 
restricts the abdomen and shuts off the blood-supply to 
the lower extremities, the blood going to the brain. 
Strong ammonia should not be held to the nostrils of 
an unconscious patient, as it is very irritating. The 
pulse should be watched, and if consciousness does 
not soon return, heat should be applied and a physician 
be sent for. Little can be done for loss of conscious¬ 
ness from heart-failure, beyond stimulating a flagging 
pulse, until the arrival of medical assistance. 

Drowning.—In asphyxia from drowning, if the person 
when taken from the water is breathing, he should be 
removed, if possible, to a near-by house, and put into a 
hot bath, which will act as a stimulant; or heat may be 
applied directly over the heart and other vital organs, 
the head and shoulders be raised, stimulants given, and 
the body briskly rubbed. This can be done until the ar¬ 
rival of a physician. In all cases of suffocation the throat 
must be cleared, so that fresh air can reach the lungs. 

Artificial respiration is the imitation, as nearly as possi¬ 
ble, of natural breathing. We breathe from sixteen to 
eighteen times a minute; this number of chest move- 

o ’ 


202 


PRACTICAL POINTS IN NURSING. 


ments must not be exceeded, or the lungs cannot ex¬ 
pand to fill thoroughly with air nor contract to expel 
the air. 

To produce artificial respiration in case of drowning or 
of suffocation, the patient’s clothing is first removed and 



Fig. 6i.—A rtificial respiration, first movement. 


the body is quickly dried. The mouth, the throat, and 
the nose should be cleared and the tongue be pulled 
forward to facilitate access of air to the windpipe; a roll, 



Fig. 62.—Artificial respiration, second movement. 


a pillow, a rolled-up coat, or a piece of wood should be 
placed under the shoulders. The arms near the elbows 
should now be grasped and be swept around horizon¬ 
tally, away from the body, until the hands meet over the 
head (Fig. 61); this movement raises the ribs and ex¬ 
pands the chest as in inspiration ; the arms should then 
be brought down to the sides, the elbows meeting almost 









ACCIDENTS AND EMERGENCIES. 203 

over the pit of the stomach (Fig. 62); pressure is then 
made against the chest-wall, producing contraction of 
the chest; the arms are to be held in the latter position 
a few seconds, and then the movements are repeated. 
Twelve or fifteen respirations will be sufficient. The 
mouth must be kept open and the tongue be held 
forward. 

Accidents from Fire.—If clothing catches fire, the 
person should be thrown down and rolled in a rug, 
shawl, blanket, or coat. Any one may at some time be 
compelled to pass through sulphur fumes or smoke, and 
it can be done by holding a wet towel, a large wet hand¬ 
kerchief, or a wet cloth over the nose and mouth. Some 
persons who have been through this experience never 
retire without first placing at their bedside a large hand¬ 
kerchief or a towel and a bowl of water, in case this 
emergency should arise. 

Retention of Urine.—Retention of urine is due to the 
patient’s inability to pass urine, owing to shock, paralysis, 
hysteria (commonly known as hysterical retention ), or 
other causes, which, if not relieved, may result in rupture 
of the bladder or uremic poisoning through resorption. 
The patient should be put into a hot bath if possible, 
which will act as a stimulant, relieve the pain, contract 
the muscular coats of the bladder, and also produce per¬ 
spiration. If the bath is impossible, a hot poultice or 
fomentation should be applied over the bladder, or cath¬ 
eterization may be practised and a simple enema be 
given. 

Head-accidents.—For all accidents to the head, the 
part is to be bathed with warm water and firm pressure 
with a clean compress be made until the arrival of a 
physician. 


204 


PRACTICAL POINTS IN NURSING. 


Concussion of the brain is the sudden interruption of 
the functions of the brain brought on by severe blows 
on, or by other injury to, the head. In the simple form 
of concussion the patient is partly insensible; the pupils 
are contracted, and the face is pale. In a few moments 
he may regain consciousness; there is nausea and vom¬ 
iting and headache. In a severe case of brain-concus¬ 
sion death may very soon occur. 

Compression of the brain is due to tumors, to depres¬ 
sion of the skull from fracture, and other causes. The 
symptoms closely resemble those of apoplexy. In both 
these injuries, until the arrival of a physician, who should 
be sent for at once, the patient should be placed in bed 
with the head slightly raised; the room should be dark¬ 
ened and cold applied to the head. If there is shock, heat 
is to be applied, but stimulants are not to be given with¬ 
out orders from the doctor. 

Cuts and Bruises.—For a cut or a bruised finger, the 
part is to be washed thoroughly with an antiseptic solu¬ 
tion or with boiled sterilized water, then with dilute alco¬ 
hol or with hamamelis (witch-hazel), and the part bound 
up with clean cotton and a bandage. 

Foreign Bodies.—A foreign body in the car should 
be removed at once. If the obstruction be an insect, 
the patient should lie on the side with the affected ear 
upward, the aural canal being straightened by pulling 
the auricle upward and slightly backward; the ear is 
then filled with warm water or with olive oil. The insect 
will then float to the top and fall out. No other liquid 
should be put into the ear without the consent of an ear 
specialist. The ear is a very delicate organ, and will be 
injured by unskilful treatment. If the foreign body is a 
bean or any object likely to swell, the ear must not be 


ACCIDENTS AND EMERGENCIES. 


205 


syringed. If the obstruction is a button, a stone, or cot¬ 
ton, one may try to syringe it out; but nothing else 
should be attempted, or the obstruction may be pushed 
farther in. A foreign body in the nose , if it can be seen, 
may be removed with a bent hair-pin or with forceps. 

An obstruction in the throat may be removed by the 
drinking of water, the swallowing of a piece of bread, 
or by a hard blow between the shoulders; if these 
measures fail, an emetic of mustard and water or of salt 
and water may be given. 

A foreign body in the eye may be removed by having 
the patient look down ; a pencil or some similar thin 
body is then placed across the upper lid, and the lashes 
are seized and the lid turned over; the exposed particle 
is then wiped off. 

Insect Bites and Stings.—Insect or mosquito bites 
are treated by bathing the part with dilute or pure vin¬ 
egar or with a solution of carbolic acid (1 :40). 

Dysmenorrhea.—Dysmenorrhea, or painful menstrua¬ 
tion, very often calls for prompt treatment, which consists 
in hot mustard foot-baths, rest in bed, the application of 
hot flaxseed poultices, or turpentine or mustard fomenta¬ 
tions to the lower part of the abdomen, and a hot-water 
bottle to the back and one to the feet. Drinks of hot 
ginger-tea or of gin will increase the circulation. It may 
be mentioned that painful menstruation is often the re¬ 
sult of tight lacing: the abdominal organs are crowded 
down upon the womb, the bladder, and the rectum, and 
the womb is forced down out of its normal position, the 
free escape of the blood thus being prevented. Expo¬ 
sure to cold during menstruation is another cause. A 
normal menstruation should be painless. 

Vomiting.—To relieve vomiting a mustard plaster or 


206 


PRACTICAL POINTS IN NURSING. 


an ice poultice over the stomach is very good. If the 
vomiting is caused by constipation, a Seidlitz or a Ro¬ 
chelle powder will generally stop it. 

Flatulence.—Flatulence is relieved by io drops of 
the oil of peppermint or 5 drops of the oil of turpentine 
on sugar every three hours, or by drinking very hot 
water. 

Toothache.—Toothache may be relieved by oil of 
cloves, oil of peppermint, or creasote applied on cotton 
and inserted in the cavity of the tooth. 

Insomnia.—Insomnia, or sleeplessness, considered as 
an emergency, may be relieved by the application of 
heat to the abdomen, and to the feet if they are cold. 
Should the patient sleep the first few hours of the night, 
then awake, and remain so during the early morning 
hours, a light meal, such as a cup of hot cocoa and a 
cracker, or even a glass of hot milk, will induce sleep 
by drawing the blood-supply from the brain to the stom¬ 
ach, and at the same time the blood will be replenished 
by substances formed in the process of digestion, that 
have a soothing effect. Wakefulness is increased if there 
is a light in the room, because the brain cannot rest un¬ 
less there is darkness : to procure this the room should 
be darkened as much as possible and a handkerchief 
folded over the patient’s eyes. 

Sunburn.—Sunburn is painful, and may be relieved 
by any kind of oil or by a wash made of sodium bicar¬ 
bonate, and by excluding the air. 

Burns by Acids and Alkalies .—A burn by an acid 
should be treated by pouring over the burn a solution 
of sodium bicarbonate and water or plain water to dilute 
the acid; the part is then dressed as for an ordinary 
burn. For a burn by an alkali, for instance, quicklime, 


ACCIDENTS AND EMERGENCIES . 207 

an acid is applied, such as lemon-juice or vinegar. For 
burns of the eye with an acid or an alkali the eye should 
be washed immediately with warm water to dilute the 
substance and to prevent its being absorbed; vaselin or 
any of the oils then should be applied. 

Frost-bite.—Frost-bite is due to extreme cold. The 
vitality of the part is lowered and the circulation in it 
ceases. Exposure to intense cold may cause death, 
owing to the action of the skin and the superficial blood¬ 
vessels being cut off; as a consequence, the internal 
organs are very much congested, which condition is 
followed by congestion of the brain, causing drowsiness, 
stupor, and coma, and ending in death. 

The treatment of frost-bite consists in rubbing the part 
with snow or with ice-water, which will gradually dilate 
the contracted blood-vessels and start up the circulation 
in the part. The patient must be kept in a cold room. 
As the temperature of the part and of the body rises, the 
patient should be rubbed gently with equal parts of alco¬ 
hol (or vinegar) and water, and the temperature of the 
room be slowly increased; or the patient may gradually 
be removed to a warmer room. The part should be 
exposed to the air for a while and then covered. Hot 
drinks and stimulants are to be given if necessary. 

The return to heat must he gradual , as the sudden 
reaction of the circulation in the part may result in 
intense inflammation and gangrene. Should inflamma¬ 
tion set in, cloths wet in equal parts of alcohol (or vine¬ 
gar) and water may be applied. 

Chilblains. —Chilblains are caused by exposure to 
cold, followed by a sudden return to heat. The treat- 
ment is the same as that for frost-bite. Patients after 
one attack should wear woollen stockings and gloves. 


208 


PRACTICAL POINTS IN NURSING. 


3. Accidental Poisoning. . 

Poison Defined. —A poison is a substance which, when 
taken into the body, produces either disease or death. 
Any substance causing death when taken into the stom¬ 
ach is a poison. Poisons may also enter the circulation 
through the broken skin. 

Classification and Action of Poisons. —Poisons are 
divided into two classes—irritants and narcotics. The 
irritant poisons act on the stomach and bowels, and the 
symptoms of all such poisons are generally the same. 
Coming in contact with the lips, mouth, throat, and 
stomach, they produce a burning sensation and give rise 
to vomiting and pain in the stomach and abdomen, the 
pain being increased upon pressure, and by purging. 
The effects of the poisons are chiefly upon these organs, 
which they irritate and influence. After all irritant poi¬ 
sons, demulcent drinks, such as flaxseed tea, white of 
eggs, glycerin, sweet oil, starch-water, or warm milk, 
should be given to soothe the inflamed mucous mem¬ 
brane. Neurotic poisons act upon one or more parts of 
the nervous system, producing headache, giddiness, 
numbness, stupor, and paralysis, and often convulsions 
and death. They have not the burning taste of irritants, 
and rarely give rise to vomiting and purging. 

What to Do in Case of Poisoning.—The first thing 
to do in all cases of poisoning is to ascertain what kind 
of poison has been taken, either from the symptoms pro¬ 
duced or from the vomited matter. If this detection is 
impossible, the stomach is to be emptied—that is, if the 
drug has been taken by mouth—to prevent the poison 
being absorbed; the antidote (a remedy to counteract 
the effect of the poison) is then to be given. If the 


ACCIDENTS AND EMERGENCIES. 


209 


poison has been absorbed, medicines are given to coun¬ 
teract its effect on the temperature, the respiration, or 
the circulation. Vomiting may be induced by giving 
mustard and warm water, salt and warm water, tepid oil 
and water (a tablespoonful to a cup of water), warm 
water, or by running the finger down the throat, or by 
tickling the throat with a feather. Vomiting is gener¬ 
ally easier if the stomach is full of food or of fluid. 
Should the stomach be empty, a quantity of fluid should 
be given before the emetic. 

When emetics are administered, they should be given 
quickly and not more than half a pint at a time, or the 
walls of the stomach may become paralyzed through 
over-distention. After vomiting, the patient should drink 
plenty of milk or water, and the bowels should be 
cleared, in case the poison has entered the intestines. 

A few of the most common poisons and their anti¬ 
dotes are the following: 

Irritant Poisons. — Carbolic Acid. —Milk and lime- 
water, equal parts; stimulants; no oil, as it will help 
absorption ; flaxseed tea, hot applications to the extrem¬ 
ities, and counter-irritation upon the abdomen. 

Carbonic-acid Gas. —Removal of patient from the 
room; artificial respiration; bathing with alcohol and 
water; application of heat to the feet; cold douching, 
friction, and stimulants. 

Oxalic , Acetic, and Tartaric Acids. —Chalk or plaster 
scraped from the wall and dissolved in water or in milk 
(in an emergency); soapsuds; emetics; stimulants, and 
heat externally. 

Prussic Acid {Hydrocyanic Acid, Cyanid of Potassium). 
—Apply smelling-salts to the nose; an emetic; black 
coffee. Action should be prompt; often there is little 
14 


210 


PRACTICAL POINTS IN NURSING. 


time for anything but hot and cold affusions to the head 
and artificial respiration. 

Sulphuric , Phosphoric , Nitric , and Hydrochloric Acids. 
—Magnesia, whiting, chalk, sodium bicarbonate, milk, 
white of egg, or plaster scraped from the wall; external 
heat. 

Ammonium. —Vinegar, lemon-juice or orange-juice, 
milk, oil. 

Ammonia , Caustic Lime , Potash , and Soda , and the 
Carbonates of Sodium and Potassium , are alkalies , and are 
treated with acids, such as vinegar and lemon-juice, and 
milk, and olive or any bland oil to soothe the mucous 
membrane. 

Arsenic and Paris Green. —Emetics; oil and lime- 
water; milk; raw eggs; flaxseed tea; powdered charcoal 
in water (half an ounce to a cup of water); heat over 
the abdomen. 

Corrosive Sublimate. —White of egg, which, being an 
albumin, will render the corrosive insoluble, or milk or 
flour and water will answer; then an emetic is given to 
remove the poison. Poisoning by copper or lead is 
treated in the same way. 

Ergot. —Stimulants ; strong tea. 

Iodin. —Emetic; flour or starch and water; white of 
egg in milk ; sodium bicarbonate. 

Phosphorus. —Emetics and purgatives; no oil, as it 
aids absorption ; poultices to stomach. 

Poison ivy when brought in contact with the skin is 
capable of exciting inflammation of its tissues. It is an 
acid, and is treated with an alkaline. Plain cold water, 
baking-soda (saleratus) and water made into a thick 
wash, lime-water, or soapsuds will help to relieve the 
inflammation. The applications should be continued 


ACCIDENTS AND EMERGENCIES. 


211 


faithfully for twenty-four hours. The parts should after¬ 
ward be dusted with powdered starch. 

Narcotic Poisons. — Aconite. —Emetics; purgatives; 
stimulants of alcohol, digitalis, or atropin to restore the 
heart’s action; heat to the body. 

Atropin and Belladonna. —Emetics; black coffee and 
stimulants ; hot and cold water alternately to the head ; 
lemon- or orange-juice and water. The patient should 
be aroused from stupor. 

Chloral. —Emetics; heat is to be applied and strong 
coffee given; hot mustard foot-baths; artificial respira¬ 
tion should be practised if necessary. The patient 
should be aroused as in opium-poisoning. 

Digitalis. —Emetics; strong tea and perfect quiet in 
bed; also cathartics. 

Opium and Morphia. —Emetics (the stomach may be 
washed out with warm water); black coffee by the mouth 
or the rectum; vinegar and water; lemon- or orange- 
juice and water. The patient should be aroused from 
stupor and kept awake by being walked about the room 
and flicked with a wet towel; a hot- and a cold-water 
douche may be given. Mustard plasters may be applied 
to different parts of the body. Blistering should be 
guarded against; the patient should be kept warm all 
through the treatment. 

Nux Vomica and Strychnia. —The stomach should be 
emptied before the convulsions begin. If an emetic is 
impossible, inhalations of ether or of chloroform should 
be given, and the stomach be washed out; chloral or 
bromid of potassium be given subcutaneously to quiet 
the convulsions; also a hot bath. Heat and friction 
are to be applied and artificial respiration is to be 
practised. 


212 


PRACTICAL POINTS IN NURSING. 


Nitrate of Amyl .—Artificial respiration ; hot and cold 
affusions. 

Quinia .—Emetics ; purgatives ; strong tea or coffee; 
hot stimulants ; artificial respiration. 

Mushrooms. —Emetics; purgatives; poultices to abdo¬ 
men ; stimulants. 

Poisoning by tainted meats or fish or by mushrooms 
is treated with emetics and purgatives. Heat and stim¬ 
ulants should be employed if there is shock. 

Bites of Rabid Animals. —Poisoned bites by a mad 
dog or by serpents should be treated by having the 
poison sucked out of the wound (unless there is an 
abrasion on the nurse’s lip), and the wound afterward 
washed with plain warm water. The patient must be 
taken at once to a physician, who will cauterize the 
wound. The patient must be given stimulants in mod¬ 
erate quantities to sustain the system. The state of the 
pulse must be taken as a guide to indicate when the 
proper amount of stimulation has been reached. 

In all emergencies the nurse must keep perfectly calm ; 
she should think what has happened and what should 
be done, and then do it quietly. If she gets excited and 
loses her presence of mind, the life of the patient may 
be lost. When notifying the physician or surgeon 
she should send a written , not a verbal message, and 
should state clearly what has happened, so that he will 
fully understand and come prepared: he should also be 
informed of what is being done by the nurse. 


NURSING IN SPECIAL MEDICAL DISEASES. 21 3 


V. NURSING IN SPECIAL MEDICAL 

DISEASES. 

1. Infectious and Contagious Diseases. 

Infectious Diseases.— Infectious diseases are caused 
by the introduction into the body of a living poison, 
which has the power of producing a disease if it can 
find therein conditions suitable for its development. 
Every infectious or contagious disease is caused by a 
specific germ—a germ which produces that disease and 
no other. Exposure to an infectious disease does not 
always produce that disease in a healthy person, because 
its germs cannot find conditions suitable for their devel¬ 
opment, so that the mere presence of the active cause in 
itself is insufficient to produce the disease. In diphtheria 
it will usually be found that the attack of the disease has 
been preceded by a local inflammation of the throat, 
thus making a suitable place for the specific action of 
the diphtheria germs. In typhoid fever the germs re¬ 
quire a suitable condition of the bowels before they can 
produce the disease. Healthy lungs are not a suitable 
location for the development and activity of the germs 
which produce consumption. On finding these conditions 
it takes the germs some days to develop and produce the 
disease; this explains what is meant by the period of in¬ 
cubation. All germs—or bacteria, as they are called— 
have their favorite seat in the body, and they leave the 
body through the lungs, the skin, the kidneys, or the 
bowels. The germs of diphtheria leave the body through 
the breath and the discharges from the nose and throat; 
those of pneumonia and of consumption (which is tuber¬ 
culosis of the lungs) leave the body through the expec- 


214 


PRACTICAL POINTS IN NURSING. 


torations, which are charged with them; those of scarlet 
fever and of measles, through the breath, skin, and dis¬ 
charges from the nose and throat; those of whooping 
cough, in the same manner as those of diphtheria; those 
of small-pox, through all the discharges; and those of 
typhoid fever, through the bowels. 

Contagious Diseases.— Contagious diseases spread by 
contact with a patient or with the corpse of one dead of 
a contagious disease, articles of clothing, etc. Some¬ 
times the disease will be communicated by a single ap¬ 
proach to a patient, though persons who have once had 
a contagious disease rarely ever have it a second time: 
this is what is meant by immunity. A child that never 
had scarlet fever if placed in the same room with one 
who has the disease will take it because of this ex¬ 
posure. The “ acute exanthemata ” are the eruptive 
diseases—scarlet fever, measles, small-pox, and chicken- 
pox. 

Another term very often heard is miasmatic disease. 
Intermittent fever and malarial fever come under the 
head of miasmatic diseases, the poison of which is found 
in the low, marshy districts. These diseases are infec¬ 
tious, but not contagious; one cannot take them by 
contact with the patient, but must get them from the 
low marshy regions supposed to be favorable for the 
propagation of these germs. 

We guard against the spread of contagious diseases 
by isolating the patient in a room at the top of the 
house, because the air there is purer, and because if the 
patient be on any of the lower floors the poison might 
spread upward through the house; by the utmost clean¬ 
liness, by keeping the air pure, by the faithful use of dis¬ 
infectants, and by hanging a sheet wet with some disin- 


NURSING IN SPECIAL MEDICAL DISEASES. 21 $ 

fectant, or even with plain water, before the door of the 
room, so that when the door is opened the germs in the 
air coming from the room will come in contact with the 
wet sheet and cling to it; by having separate dishes 
and utensils for the room and the patient, and separate 
bed- and body-linen, and by thoroughly disinfecting the 
movements and expectoration before disposing of them. 
The very best way to treat the latter is to mix them with 
sawdust and then burn them. 

Typhoid Fever. —Typhoid fever is an acute infectious 
disease due to the entrance into the body of a special poi¬ 
son by drinking impure water or milk, through bad air or 
drainage, or from a previous case of typhoid fever where 
no precautions were taken against the spread of the dis¬ 
ease. It is also called enteric fever, slow fever, low fever, 
and nervous fever, and is characterized by ulceration of 
certain parts of the bowels. In mild cases the stage of 
ulceration may not be reached. The period of incuba¬ 
tion is from two to three weeks. 

Symptoms .—Some of the symptoms are headache, 
aching pains in the back and the limbs, loss of appetite, 
increasing weakness, nausea, sleeplessness, depression, 
a chilly feeling, nose-bleed, slight diarrhea, gradual rise 
of temperature -and increase of pulse, coated tongue, 
stupor, and delirium. There may be coma vigil , the 
patient lying perfectly quiet with his eyes open, but 
paying no attention to what is going on around him. 

The temperature gradually rises morning and evening 
until it reaches 104°, sometimes 105° F., with a corre¬ 
sponding increase in the pulse-rate. During the second 
week the temperature is high and varies very little; it 
begins to descend gradually during the third week, the 
morning temperature being one or two degrees lower 


216 


PRACTICAL POINTS IN NURSING. 


than that of the evening. During the fourth week the 
temperature is almost normal in the morning, and rather 
irregular. A sudden drop would indicate hemorrhage 
or perforation of the bowels. The pulse is generally 
rapid, and in severe cases may be dicrotic. 

About the second week rose-colored spots appear on 
the chest, the back, and the abdomen. These spots are 
slightly elevated and disappear upon pressure. Each 
spot lasts about three days, a few fresh ones appearing 
every day or two until the third week, when they dis¬ 
appear. The eruption may be absent in the old and the 
very young. The third week is an anxious week, as then 
very often the symptoms are at their worst. The patient 
may have a relapse, which is another course of the fever; 
but generally the duration of the disease following a 
relapse is not so long as the first attack. It is, however, 
a very serious time, the patient’s strength being very low. 

The nursing consists in keeping the patient quietly in 
bed, the bed- and body-linen sweet and clean, the air of 
the room fresh and pure, and the temperature 65° F. The 
typhoid germ is eliminated from the body through the 
discharge from the bowels, and the smallest portion of 
fecal matter can produce the disease in another person. 
There may be diarrhea, the movements being loose and 
yellowish in color, with an offensive odor, or there may 
be constipation. After a recent hemorrhage the move¬ 
ments are dark red, containing blood; but if not passed 
for some time after the hemorrhage has taken place, 
they will be black, resembling tar. 

The excreta must be thoroughly disinfected with 
chlorid of lime (1 pound to 4 gallons of water, 1 quart 
being well stirred in each dejection), or with whitewash 
or a solution of carbolic acid (] : 20). Corrosive subli- 


NURSING IN SPECIAL MEDICAL DISEASES. 21 J 

mate is not so good, as it hardens the albuminous mate¬ 
rial which covers the outside of all fecal masses, and 
thus protects the inside from its action. In the absence 
of all disinfectants boiling water may be used, or the 
movements may be mixed with sawdust and burned. 
The feces must not be emptied near a well nor any place 
where the water-supply would become contaminated. A 
disinfectant should be poured into the bed-pan before it 
is carried to the patient, and on its removal it should be 
covered with a cloth wet in carbolic-acid solution. Bed- 
and body-linen soiled with fecal matter must be thor¬ 
oughly boiled. 

Sometimes there is a constant dribbling of urine 
through over-distention of the bladder. This trouble is 
easily remedied if the catheter be passed. There may 
be retention or suppression of urine. Retention exists 
when the bladder is full of urine, the patient being 
incapable of urinating; in suppression the bladder is 
empty, no urine having been secreted by the kidneys. 

The nurse should report any cough, the character of 
the expectoration, and nose-bleed; also delirium, which 
very often occurs, and which may be mild, active, or 
violent. She should be very kind and gentle, but firm; 
she should not leave the patient alone for a single mo¬ 
ment, but should wait until some member of the family 
can relieve her or bring what she needs. She should 
report any symptoms of pain in the ear, discharge from 
the ear, or deafness, which is not uncommon. The 
mouth of the patient must be kept perfectly clean; it 
should be washed at least three times daily to prevent 
the collection of sordes, a dark-brown accumulation on 
the teeth, gums, lips, and tongue. 

The diet will be liquid food, which is easily digested; 


2 l8 


PRACTICAL POINTS IN NURSING. 


a more solid diet would irritate the intestines and cause 
perforation. Milk will probably be ordered. For an 
adult two quarts should be given in small quantities 
every one or two hours during the twenty-four hours ; 
the milk may be flavored with tea, coffee, cocoa, vanilla, 
or any flavor for which the patient has a fondness. 
Should the milk not digest, as will readily be deter¬ 
mined by the presence of milk-curds in the dejections, 
this fact should be reported to the doctor. 

A few words may be said here about the drinking of 
milk. Many patients will drink half a glass, and often a 
whole glass, of milk at one time, and soon afterward will 
complain of a feeling of indigestion and want very hot 
water to drink. Milk curdles as it is swallowed, and if a 
large quantity is drunk at once, it forms in the stomach 
a large hard mass, and the juices of the stomach can 
act only on the outside of it; whereas if the milk is 
drunk in little sips, it forms a loose mass of small lumps, 
and the juices of the stomach can work around and 
through them, and thus dissolve the whole in a very 
little time. The milk diet may be alternated with 
beef-tea, chicken-broth, oyster-broth, coffee, or cocoa. 
Oysters contain an amount of albumin, are very nour¬ 
ishing, are easily digested, and are often retained when 
all else fails. One oyster, fresh from the shell, may be 
given every hour or half hour. It should be remem¬ 
bered that the patient’s mouth and lips are very often 
parched and dry; therefore they should be moistened 
before feeding. The patient should always be awakened 
for treatment in the daytime, but the doctor should be 
asked if he is to be awakened during the night. 

Thirst may be relieved with crushed ice, lemonade, 


NURSIiVG IN SPECIAL MEDICAL DISEASES. 2 ig 


or orangeade. The patient should also be supplied with 
plenty of cool filtered or distilled water or with Vichy 
water. The object of giving the patient plenty of pure 
water to drink is to flush out the kidneys and to aid in 
the elimination of the worn-out material generated in the 
body by the fever. 

The temperature is reduced by means of tepid spong¬ 
ing, the cold pack, and the tub-bath (see pages 83, 88, 
89). Besides reducing the temperature, baths soothe and 
quiet the patient. 

Complications .—Some of the complications of typhoid 
fever are pneumonia, hemorrhage, peritonitis, perfora¬ 
tion, and diarrhea. 

Two of the most dreaded complications of typhoid 
fever are hemorrhage and perforation , and it is the lia¬ 
bility to these two complications that makes it absolutely 
necessary for the patient to keep perfectly quiet, not ris¬ 
ing for anything without direct orders from the doctor, 
be the case ever so mild, as sitting up causes pressure 
upon the ulcerated part, and might result in perforation. 
Purgatives must not be given by a nurse on her own 
responsibility, as they might irritate the bowels and 
cause perforation. 

Hemorrhage .—The intestines, though very thin, are 
supplied with large and small blood-vessels. In typhoid 
fever the intestines are in some parts ulcerated: one of 
the ulcers may eat its way into a blood-vessel and cause 
hemorrhage, which is indicated by a sudden fall of tem¬ 
perature, a small, rapid pulse, a pale face, an anxious 
expression, restlessness, demand for air, faintness, and 
blood in the movements. 

With children ulceration of the bowels is less likely 


220 


PRACTICAL POINTS IN NURSING. 


than with adults, consequently the dangers of hemor¬ 
rhage and perforation are less. The rash may be absent, 
but the brain-symptoms are marked, and generally the 
temperature rises suddenly. In very old people the rash 
may also be absent. 

Treatment of Hemorrhage. —In treating hemorrhage 
the foot of the bed should be raised as high as possible. 
If the bedstead cannot be raised, then the bed-spring 
should be raised and the head of the patient should be 
lowered. Ice or ice-cold cloths may be applied to the 
abdomen. Morphia (gr. |-) may be given hypodermatic- 
ally ; it will both stimulate the heart and secure rest 
and quiet. The patient must be kept perfectly quiet on 
the back, so that the blood will coagulate in the vessels 
and prevent further hemorrhage. 

Perforation is due to the breaking of an ulcer of the in¬ 
testine ; the contents of the bowels then escape into the 
abdomen, causing inflammation of the peritoneum, and 
resulting in peritonitis. The symptoms of perforation are 
sudden and sharp pain in the abdomen, which is distend¬ 
ed and tender, vomiting, a fall of the body-temperature, 
a small, rapid pulse, and all the symptoms of collapse. 

Treatment of Perforation. —The treatment until the 
arrival of the physician consists in the application of 
hot fomentations to the abdomen and down the limbs, 
stimulation, and morphia (gr. to secure rest and quiet 
and to relieve the pain. 

The nurse must be calm, cheerful, and equal to any 
emergency. Whatever happens, she should not let her 
patient know, either by word or by look, that there is 
anything wrong; she must remember that the patient is 
watching her very closely, and is guided by the expres¬ 
sion of her face. 


NURSING IN SPECIAL MEDICAL DISEASES. 221 


Tympanites , which is distention of the abdomen through 
the accumulation of gas in the bowels, is relieved by 
turpentine fomentations or by plain poultices and the 
rectal tube. 

Bed-sores may be prevented by bathing the patient’s 
back with alcohol or with a solution of salt and whisky 
(2 teaspoonsful of salt to a pint of whisky), or by pow¬ 
dering the back with oxid of zinc, fuller’s earth, pow¬ 
dered starch, corn-starch, bismuth, or borax. If the skin 
breaks, the part should be covered with the white of egg. 
When the urine and the feces are passed involuntarily 
or when there is much skin moisture, rubbing the back 
with olive oil or vaselin will prevent the moisture from 
being absorbed. In the absence of alcohol, the parts 
should be kept perfectly clean with soap and water; the 
sheets should be kept dry and free from wrinkles; pres¬ 
sure should be removed and the position of the patient 
should be changed often. 

Convalescence .—During convalescence there may be a 
temporary rise of temperature, due either to excitement, 
change of food, or constipation. The diet should be 
light, such as custards, puddings, cream-toast, soft-boiled 
eggs, and jellies. A return to solid diet should be made 
only with the doctor’s permission. Very few visitors 
should be allowed. The nurse should be faithful in the 
use of disinfectants, and should never go to her meals 
without first washing her hands thoroughly with soap 
and water and a brush. The germs enter the body by 
the mouth ; hence by the thorough washing of her hands 
before eating the nurse will guard against the germs of 
the disease—typhoid or any germ-disease of which she 
has the care—being swallowed with the food. 

Walking Typhoid Fever .—“ Walking ” typhoid fever, 


222 


PRACTICAL POINTS IN NURSING. 


as a rule, is of a mild character; the patient refuses to 
give up and go to bed. Still, there is always the danger 
of grave symptoms developing and resulting in death. 

Scarlet Fever.— Scarlet . fever is synonymous with 
scarlatina. It is an acute infectious contagious disease 
characterized by high temperature, rapid pulse, head¬ 
ache, vomiting, sore throat, and rash. The tongue is 
coated, which coating after a few days disappears and 
the papillae become prominent and bright red—the 
“ strawberry tongue,” as it is called. The bowels are 
constipated, the urine scanty and high-colored. On the 
second day of the disease the rash appears. It be¬ 
gins as small red dots on the chest and neck, and 
gradually extends until the whole body is a bright scar¬ 
let. About the fifth day the temperature begins to fall, 
and gradually decreases, the eruption fades, and desqua¬ 
mation or peeling begins. Very often large scales will 
come off the hands, the feet, and the abdomen. This 
peeling lasts for two or three weeks. 

In the malignant form the rash comes out late, the 
temperature is very high, and death often takes place in 
from two to three days; while in the simple form the 
rash is present, but there is very little throat trouble. 
With children scarlet fever is often ushered in with 
convulsions. 

The treatment of scarlet fever lies in isolating the pa¬ 
tient in a room as far away from the family apartments 
as possible, and in removing all unnecessary articles 
from the room. If two adjoining rooms can be used, 
the medicines, dishes, disinfectants, etc. should be kept 
in the second room; if only one room is available, a 
screen may be improvised by covering a clothes-horse 
with a shawl, a blanket, or a sheet, and behind this screen 


NURSING IN SPECIAL MEDICAL DISEASES. 223 

everything may be kept. A small table may be placed 
outside the room, and provided with a slate upon which 
the nurse writes her requirements, the things needed 
being left for her on this table. 

The nurse should keep the air of the room perfectly 
pure and the temperature at 65° F. When ventilating 
the room, she should take care that the air does not 
blow from the sick-room into the other rooms of the 
house. A sheet wet with some disinfectant should be 
hung over the door. Nothing must leave the room 
without first being washed in a disinfectant or in boiling 
water. The diet is liquid. The patient should be given 
to drink plenty of pure cold water, which will flush out 
the kidneys and aid in eliminating the worn-out mate¬ 
rial generated in the body. 

Baths or cold packs may be ordered to reduce the 
fever, followed by oiling of the 'body with cocoa-butter, 
sweet oil, or vaselin. This treatment, besides reducing 
the fever, will assist the peeling and prevent the scales 
of skin flying about, and thus act as a preventive against 
the spread of the disease. The nurse should have every¬ 
thing ready before beginning the bath, and the bed- and 
body-linen thoroughly aired before being changed. 

The nose, mouth, and throat of the patient should be 
kept perfectly clean. Soft rags should be used to wipe 
away the fecal discharges, and they should be burned as 
soon as used; if this is impracticable, they should be 
thrown into a pail of disinfectant. If the throat is 
ordered to be sprayed, the nurse should stand a little 
to one side when spraying, so that the patient will not 
cough in her face. 

The ears of the patient should be watched very closely, 
and any pain or discharge should be reported to the 


224 


PRACTICAL POINTS IN NURSING. 


physician. Inflammation of the middle ear, a very com¬ 
mon condition after scarlet fever, and deafness, are often 
due to carelessness on the part of the nurse. If the pain 
is severe, one may, until the arrival of the doctor, try hot 
flannels or a bag, made in half-moon shape, filled with 
salt and heated. This bag should be applied around 
the ear, never over it, because the heat might cause the 
walls of the canal to swell, which would bring them 
together. Dry heat will give great relief. 

Complications. —Uremia, dropsy, and nephritis (inflam¬ 
mation of the kidneys) are complications very apt to 
appear. The urine must carefully be watched and meas¬ 
ured. The nephritis and dropsy may be due to cold 
taken during a bath or during convalescence, either 
through carelessness of the nurse or obstinacy of the 
patient. The symptoms of dropsy are puffiness of the 
face, the eyelids, and the limbs, paleness, headache, and 
smoky-colored urine. With children uremia is very 
often ushered in with convulsions. Uremia is caused by 
urea (a very poisonous substance of the urine) being re¬ 
tained in the body, owing to the kidneys not properly 
doing their work. The symptoms of uremia are head¬ 
ache, suppression of urine, nausea, and the odor of urine 
in the breath ; unless relieved, these symptoms are fol¬ 
lowed by convulsions, coma, and death. The pulse is 
slow and full; the temperature is subnormal. 

Uremic convulsions may be relieved by a hot pack or a 
hot-air bath, and morphia (gr. f) hypodermatically ad¬ 
ministered if possible, which will quiet the spasms, en¬ 
courage perspiration, and stimulate the heart. An enema 
or a cathartic of oil or of Epsom salt may be given to 
clear the bowels. Hot fomentations or poultices may be 
applied over the kidneys to relieve the suppression of urine. 


NURSING IN SPECIAL MEDICAL DISEASES. 225 

Delirium must at once be reported. Should it set in 
after the physician has made his visit, cold may be 
applied to the patient’s head. 

Depression must be met with stimulants. The patient 
should be well nourished, as the fever is very exhausting. 

Convalescence .—The patient will probably require iso¬ 
lation for four weeks, be the case ever so mild. A thor¬ 
ough bath and a complete change of clothing must be 
given before he goes into another room. Some doctors 
like the patient to be in an adjoining room for two weeks 
before mingling with the family. The patient must be 
kept away from all draughts. The convalescence is 
slow and must be guarded. 

Typhus Fever.—Typhus fever is an acute contagious 
disease caused by an infecting germ and influenced by 
overcrowding, bad food, bad air, and impure drinking- 
water. 

Symptoms .—Typhus fever begins abruptly with a chill, 
followed by high fever, severe pain in the head, the back, 
and the limbs, muscular weakness, and great prostration. 
The temperature rapidly rises, and about the third or 
fourth day it is 104 or 105 0 F., with a corresponding 
increase of pulse, from 120 to 130 beats, which are at 
first full, bounding, and compressible, and later weak 
and often dicrotic. The bowels are constipated, the 
urine is scanty and high-colored, the face is dusky, and 
the tongue is covered with a whitish fur which in severe 
cases becomes black. There is also a peculiar odor 
characteristic of the disease. 

About the fifth day there appears over the body an 
eruption, consisting of rose-colored spots, which after 
two or three days become darker. The difference be¬ 
tween the rash of typhoid and that of typhus fever is 
15 


226 


PRACTICAL POINTS IN NURSING. 


that the eruption of typhus does not appear in successive 
crops, it does not disappear upon pressure, it begins to 
fade from the end of the first week to about the middle 
of the second week, and is much darker. 

In severe cases death may take place in a few days 
from coma or from heart-failure, while in mild cases the 
improvement begins about the end of the second week, 
the temperature falls suddenly, and convalescence is 
rapid. 

Treatment .—The patient is to be isolated, and disinfec¬ 
tion of the clothing and the excreta must be thoroughly 
effected. The exhaustion, which is extreme, is met with 
stimulants. Bed-sores and heart-failure are to be guarded 
against. All visitors are to be excluded, and the patient 
is to be kept bodily and mentally quiet. The nurse must 
not hesitate to feed the patient by the rectum if it be¬ 
comes necessary. The high temperature is treated with 
cold baths or packs; the headache and delirium are 
treated with cold applied to the head and absolute quiet 
maintained. The air of the room must be kept fresh and 
pure, and the temperature even. 

The complications of typhus fever are catarrhal pneu¬ 
monia, inflammation of the kidneys, and swollen paro¬ 
tid glands. 

Small-pox.—Small-pox is an acute contagious dis¬ 
ease. The varieties are—discrete, confluent, malignant, 
and varioloid or modified small-pox. 

Symptoms .—The disease begins with a chill, high fever, 
vomiting, intense pain in the back, limbs, and head, sleep¬ 
lessness, and a full and rapid pulse (from ioo to 120 or 
more). The temperature reaches its height (104-105° 
F.) about the second day, and at the fourth day it begins 
to fall. About the third day the eruption begins to 


NURSING IN SPECIAL MEDICAL DISEASES. 22 J 

appear on the forehead and face, and consists of small, 
round, elevated red spots, which feel like shot. When 
the eruption appears the temperature falls and the pa¬ 
tient feels very comfortable. The eruption gradually 
spreads over the entire body. On or about the sixth 
day these small hard spots become clear vesicles or 
blisters, and two or three days afterward they change to 
pustules; then the secondary chill sets in, the tempera¬ 
ture rises to 104 or 106° F., with a corresponding 
increase in the pulse. Pus oozes from the pustules, 
which in about three days dry up and form crusts hav¬ 
ing an offensive odor. After a week or so these crusts 
fall off and leave the “ pock-marks.” There is delirium, 
the face is swollen, the features are disfigured and often 
unrecognizable, the bowels are constipated (though there 
may be diarrhea), and the urine is scanty. The second¬ 
ary fever in a mild case may gradually subside on the 
third or the fourth day, and convalescence set in. 

In the confluent form the pimples are very abundant 
and they run together; there is a fetid discharge from 
the nose and the throat. The symptoms are more severe 
than in the discrete form. 

The malignant form ends in death in a few days, 
before the rash appears. Varioloid , or the modified 
form, occurs in a person who has either been vaccinated 
or has had a previous attack. 

The nursing consists in isolating the patient and using 
every precaution against the spread of the disease. 
Members of the family must protect themselves by vac¬ 
cination ; the air of the room must be kept pure, and 
the temperature even (about 65° F.). The fever may be 
treated by cold baths or packs, and pains in the limbs 
and back, either by ice or by heat—whichever is the 


228 


PRACTICAL POINTS IN NURSING. 


more comfortable to the patient. The pitting can to a 
certain extent be prevented by darkening the room, 
keeping it thoroughly ventilated, covering the patient’s 
face with a mask soaked in either carbolic-acid or corro¬ 
sive-sublimate solution, or by applying some simple oint¬ 
ment which will relieve the pain and heat. To prevent 
scratching, the patient’s hands may be tied up in soft 
cloths. 

When the crusts fall off they must be burned. The 
eyes, nose, and mouth must be kept clean, being washed 
several times a day. The diet consists of milk, broths, 
egg-nog, oysters (which are almost all albumin), oyster- 
broth, and beef-juice. Crushed ice, lemonade, or soda- 
water may be given to relieve the thirst. Stimulants 
may be given if necessary. 

After the case is ended everything that can be burned 
must be so destroyed, and the room and the furniture be 
fumigated and disinfected several times (see p. 234). It 
is a dread disease, and the germs, like those of scarlet 
fever, are very long lived. 

Measles.—Measles begin with all the symptoms of a 
severe cold. About the third day the rash appears on 
the face and forehead, and then spreads over the body. 
It consists of small red spots of different sizes, slightly 
elevated. The temperature rises to 102° F., and in¬ 
creases when the eruption appears. At the end of two 
or three days the eruption fades, the temperature sud¬ 
denly falls, and desquamation, or peeling, begins in the 
form of a fine branny powder, very unlike the peeling 
seen in scarlet fever. 

The Nursing .—The patient is to be isolated, as the 
disease is contagious; the temperature of the room 
should be even (about yo° F.), and the room must be 


NURSING IN SPECIAL MEDICAL DISEASES. 22 g 

slightly darkened on account of the condition of the 
eyes. Baths should be given to assist the peeling. The 
diet is either liquid or of light food, according to the 
amount of fever. The bowels must be kept regular. 
The eyes, nose, and mouth must be kept perfectly 
clean. The patient must be guarded against exposure 
to draughts, and must be kept in bed, be the case ever 
so mild, until the peeling is over. After the patient has 
left the room any tendency to cough must be reported. 
Disinfection and fumigation should be practised as for 
scarlet fever (see pp. 223, 234). 

Complications .—Some of the complications are pneu¬ 
monia, bronchial catarrh, and inflammation of the eyes, 
nose, throat, and ears. 

Diphtheria.—Diphtheria is an extremely infectious 
disease, the germs of which have their seat in the throat. 
The poison is carried through the body, and may give 
rise to certain forms of paralysis, which is partly due to 
the action of the poison on the nervous system, and 
partly to its interference with the nutrition of the va¬ 
rious tissues of the body. 

The temperature ranges from ioo° to 105 °, or 106° F. 
in severe cases, with a correspondingly increased pulse. 
The tonsils are red, swollen, and covered with membrane. 
This membrane may be of a gray or a yellowish-white 
color, and gradually change to a dull gray. When 
the membrane extends to the nose and the larynx, this 
condition will be manifested by an offensive discharge 
from the nose and nose-bleed, and by a gradual loss of 
the voice and difficult breathing. Soft cloths should be 
used to wipe away the discharges from the nose and the 
mouth ; these cloths must be burned or thrown into a 
disinfectant as soon as used. The discharges are highly 


230 


PRACTICAL POINTS IN NURSING. 


infectious. All cuts and scratches of the nurse’s hands 
should be covered, as the smallest amount of discharge 
that may get on any raw surface is capable of producing 
blood-poisoning. 

The Nursing .—The patient must be isolated. The 
room is to be properly ventilated, and the temperature 
of the room should be 65° F. Moist air may possibly 
be ordered, which can readily be secured by keeping pans 
or kettles of boiling water in the room, or, if there is a 
fire in the room or furnace-heat, by wringing sheets out 
of water and hanging them up to dry. 

Steam inhalations may be ordered for the throat, or 
gargles or sprays. Peroxid of hydrogen is very com¬ 
monly used for the destruction and elimination of the 
false membrane, and if the throat is not very sensitive, 
this drug may be used undiluted, applied with a swab. 
If this cannot be done, the throat may be sprayed with 
one part of peroxid of hydrogen to 4 parts of water. 
A glass atomizer must be used, because the peroxid of 
hydrogen decomposes when in contact with metal. 

The antitoxin treatment for diphtheria is the injection 
into the body (generally into the broad of the back) of 
antitoxin serum, by means of a large hypodermic syr¬ 
inge. The operation is performed by the attending physi¬ 
cian. The wound is sealed with a collodion dressing. 

The nourishment and stimulants must faithfully be kept 
up. Often the throat is so swollen that the patient cannot 
swallow, and resort must be had to nasal or rectal feeding-. 
Crushed ice or ice-cream will prove very grateful to the 
patient, besides helping to reduce the inflammation. The 
ice-cream adds to the amount of nourishment taken, as 
it is made of milk and eggs. Paralysis of the muscles 
of the throat is not uncommon, and the patient must not 


NURSING IN' SPECIAL MEDICAL DISEASES. 231 

return to solid diet without permission from the doctor. 
There may also be temporary paralysis of the muscles 
of the eyes and of the limbs. 

The nurse must watch the urine; it will be high-col¬ 
ored and scanty, and there may be retention, owing to 
paralysis of the bladder. The depression is very great, 
and heart-failure often occurs through sudden sitting up 
or sitting up too soon. The patient must not be allowed 
to sit up without direct orders from the doctor. 

The nurse must guard herself by good, nourishing 
food, fresh air, and the faithful use of disinfectants. The 
germs are less likely to infect the lining membrane of 
the throat and larynx if these parts are in a healthy 
condition; but when the tonsils are inflamed the germs 
find the conditions necessary for their development, and 
diphtheria is the result. When the case is ended thor¬ 
ough disinfection is necessary. 

Tracheotomy is often performed in diphtheria when the 
larynx is obstructed through extension of the diphtheritic 
membrane and there is danger of suffocation. It is also 
performed in membranous croup for the same reason as 
that in diphtheria. With the instruments the nurse has 
very little to do, but she must have at hand plenty of hot 
water , basins, tape, scissors, strong white thread, a fan, 
stimulants, sponges, a firm, hard table, and a small 
pillow, which can be made of a folded sheet. The patient 
is placed on the table, and the clothing is slipped well 
under the shoulders ; the patient is then rolled in a sheet 
or a blanket, which is pinned securely, so that he cannot 
struggle or get loose (PI. 3). If the nurse is asked to 
hold the head, she should hold it firmly and not too far 
back, lest the patient be suffocated before the operation 
is begun. When the trachea is opened there will be a 


232 PRACTICAL POINTS IN NURSING. 

rush of air and mucus; then the silver tube (Fig. 63) 
will be inserted and secured by the tape, which is passed 



Fig. 63.—Tracheotomy : a, tracheotomy-tube; b, tracheotomy-tube in position. 


through the slits on each side of the shield, and carried 
round the neck and tied at the side (Fig. 63). The 
trachea-tube is made double, so that the inner one may 
be taken out and cleansed. The after-care consists of 
three things: faithfulness in maintaining the patient’s 
strength with nourishing food and stimulants, keeping 
the tube free from membrane, and the air of the room 
moist and warm (temp. 8o° F.), because in tracheotomy 
the air does not first go through the nostrils and become 
warmed before reaching the lungs, but it goes directly 
to the lungs through the tube. This protection is 
further effected by folding a light muffler of gauze over 
the aperture of the tube. The patient may be fed by 
the rectum if necessary. 

Everything should be made ready before beginning to 



DIPHTHERIA 


Plate 3. 




2 

x. Position of patient for tracheotomy; 2. Intubation: inserting the tube (from An American 

Text-Book 0/ the Diseases of Children ), 




















DIPHTHERIA. 


Plate 4. 



2 


Croup-tent for steaming and calomel-fumigation (Northrup): i. Croup-tent open. The 
fumigation-apparatus, standing on the table, consists of a Bunsen burner, a tripod, and a plate 
containing calomel; 2. Calomel-fumigation: croup-tent closed, nurse watching the child while 
lumigation is going on. 



































NURSING IN SPECIAL MEDICAL DISEASES. 233 

cleanse the inner tube, which should not be kept out 
longer than necessary. If the tube is oiled a little, its 
removal will be facilitated and the mucus prevented from 
accumulating. The discharge should be noticed—if it be 
thin, dry, or moist. A small piece of flannel or of cot¬ 
ton-wool spread with vaselin and placed between the 
tube and skin will protect the edges of the wound 
against the pressure of the tube and prevent irritation 
and chafing. 

Should the tube suddenly be coughed out, it should 
quickly be replaced; if this is impossible, a small cath¬ 
eter may be inserted or a small rubber tube, which can 
be kept in position by means of a safety-pin run through 
the end of the tubing, a cord or tape being slipped 
through each side of the pin and tied around the neck. 
Should either of these measures fail, then the part should 
be kept wiped out with absorbent cotton, and the patient 
raised in the best breathing position possible until the 
arrival of the doctor, and stimulants be given if neces¬ 
sary. 

Intubation. —This, as the above operation, is performed 
when the larynx is obstructed either from acute or 
chronic disease or from a foreign body. The duties of 
the nurse in intubation will be, in case the patient is a 
child, to hold the child upright in her arms, with its 
knees placed firmly between her own, while an assistant 
stands behind her chair and holds the head in the proper 
position (PL 3). The patient should be fed well; he 
will swallow better with the head to one side. Ice¬ 
cream, crushed ice, and all foods in small amounts may 
be given. 

If the tube is coughed up or swallowed, the doctor 
must be informed. If swallowed, it will probably pass 


2 Id PRACTICAL POINTS IN NURSING. 

through the bowels without any trouble. It may not be 
necessary to reinsert the tube; however, it is always 
well to ask the doctor what to do under such cir¬ 
cumstances. 

Fumigation of Sick-room after Contagious Diseases: 
Sulphur Fumes .—After recovery or death of a patient 
from contagious disease everything in the nature of 
books, playthings, etc. that can be burned should be 
so destroyed, and the remaining things be washed 
thoroughly in carbolic-acid solution (i : 20) or in boil¬ 
ing water, and the room fumigated. The germs, which 
are very long lived, may lie hidden in clothes, books, 
and other things if these are packed and laid away; 
they will also lie in the corners of a room, and will 
develop months or even years after the case has ended 
and do all the harm of which they are capable. The 
fumigation should be very thorough. All the cracks 
in the room should be closed either by stuffing them 
with cotton or by pasting paper over them. All draw¬ 
ers and closets should be opened, and the pillows and 
mattresses should be ripped. A tub or a large pan 
should be partly filled with water, and in this be placed 
two or three bricks on which to stand a smaller pan. In 
this smaller pan is put the roll sulphur, which must be 
broken up into very small pieces and be saturated with 
alcohol. The water in the large pan will both guard 
against fire and furnish moisture in the form of steam. 
After everything is secure and there is no possible way 
for the sulphur fumes to escape the sulphur is ignited. 
If alcohol is not at hand, a few red coals will ignite the 
sulphur. The room door is now closed, the key-hole 
and all the cracks of the door are stopped up, and the 
room is left for twenty-four hours, when it is opened and 


NURSING IN SPECIAL MEDICAL DISEASES. 235 

aired for twenty-four hours longer; then everything, in¬ 
cluding the walls and floors, must be washed with either 
corrosive-sublimate (1 : 1000) or carbolic-acid solution 
(1 : 20) and exposed to the action of the sun and air for 
a number of days. 

If, when preparing the room for fumigation, a hole is 
bored through the middle of the top window-sash, and 
there is passed through this hole a piece of rope of suf¬ 
ficient length to extend to a window below, the sick-room 
window can be opened from the outside at the end of 
the fumigation. When closing up the cracks in the sides 
of the window care should be taken that they are filled 
in securely, so that the sulphur fumes cannot escape 
through them, but at the same time that the window 
can easily be pulled open. 

Moist fumigation is obtained by filling the room with 
steam generated from kettles of boiling water, or, if there 
is a register or a fire in the room, by hanging up wet 
sheets or wet blankets. This procedure is continued 
until moisture falls from the walls and the furniture, to 
which moisture the germs cling; then, while still moist, 
the walls, furniture, and floor are thoroughly washed 
with corrosive-sublimate solution (1 : 1000), and after¬ 
ward exposed to the influence of the sun and air. 

Another method of disinfection is to close the room 
for twelve hours, until the dust has settled, and then to 
wash off the furniture with corrosive-sublimate solution 
(1 : 1000). Newspapers are then spread upon the floor 
and the walls are rubbed with stale bread; the crumbs 
fall upon the newspapers, which are afterward taken up 
and burned. The disadvantage of this method lies in 
the inability to get into the crevices. 

When a patient dies of a contagious disease, the body 


236 


PRACTICAL POINTS IN NURSING. 


should be washed with a disinfectant and be wrapped in 
a sheet wrung out of the same; the funeral must be 
strictly private. 

The dress of the nurse must be of wash material, and 
she should wear a close-fitting cap. A member of the 
family should relieve her at meal-times and when she is 
sleeping. She should not eat nor sleep in the sick-room 
if this can possibly be avoided. She should go out for 
a while each day, no matter how tired she may be, first 
making an entire change of clothing, or she should go 
into an adjoining room, open the window top and bot¬ 
tom, and walk up and down before the open window. 

Phthisis is tuberculosis of the lungs, commonly called 
“ consumption,” and is infectious through the expectora¬ 
tions if the latter are allowed to dry, the germs of the 
disease being blown about in the dust. A sputum-cup 
(Fig. 64) containing some antiseptic solution should be 
used by the patient and be cleaned at least three times a 
day. The other excretions must also be disinfected. If 
the patient is able to go about, he should be told the 
importance of expectorating in pieces of soft cloth, which 
can be burned, and not in handkerchiefs, which are to be 
washed. Kissing must not be allowed, as the infection 
can be transmitted by sores that may be on the lips; 
neither should a healthy person sleep in the same room 
with a consumptive. It is very important that cuts and 
scratches on the hands should be well covered, as there 
is danger of the sputum coming in contact with such 
injuries and of the germs entering the body through 
the broken skin. The nurse will therefore see how 
essential it is, when on duty in contagious cases, to take 
great care of her hands. The same precaution applies 
to the patient, all cuts and scratches being covered so 


NCJRSING IN SPECIAL MEDICAL DISEASES 237 

that the sputa or the excretions cannot come in contact 
with the wounds, and in keeping the skin perfectly 
clean. 

Forms of Phthisis .—There is an acute and a chronic 
form of phthisis : the acute form at first is not unlike pneu¬ 
monia; there is chill, a rise of temperature, profuse per¬ 
spiration, difficulty in breathing; the expectorations at 
first are rust-colored, and afterward become purulent- 
All these symptoms rapidly increase, and death occurs 
in a few weeks or a little longer. In the chronic form 
the patient may linger for years. 

Patients with phthisis, whose cases are generally hope¬ 
less, esteem the kind attention of the nurse, there being 
very little that can be done for them beyond making 
them as comfortable and as happy as possible. 

Simple Croup.—Simple croup or false croup is a dis¬ 
ease of children, and begins with all the symptoms of a 
severe cold—dry cough and suppressed voice, caused 
by mucus collecting in the nostrils and larynx, which 
becomes dry and hard; consequently the patient is in 
great distress and makes spasmodic efforts to breathe. 

The patient should be propped up in the best breathing 
position, and hot fomentations applied to the throat; an 
effort should be made to produce vomiting with luke¬ 
warm water and salt, or by tickling the throat, or by 
running the finger down the throat, followed by any 
kind of oil, melted vaselin, mutton tallow, etc. A cold 
cloth should be wrapped around the neck and the pa¬ 
tient put into a hot bath (temperature from ioo° to 102° 
F.), and a simple enema to clean the bowels should be 
given. The temperature of the room must be kept 
even (70° F.), and the air moist. The attack usually 
occurs at night, and a second attack can generally be 


238 


PRACTICAL POINTS IN NURSING. 


prevented by keeping the bowels open and by not allow¬ 
ing the child to sleep uninterruptedly through the night; 
it should be given a drink of milk or of water, which 
will tend to prevent the mucus collecting. 

Membranous Croup.—Membranous croup, or true 
croup, is by most authorities considered the same as 
diphtheria. The mucous membrane lining the larynx is 
inflamed, and a tenacious mucus covers the swollen 
membrane, which gradually thickens until the breathing 
is obstructed. There is high temperature (102-104° F.) 
and a small, rapid pulse. Until the arrival of the doctor 
the nurse can only apply the same remedies as those 
used for simple croup. Stimulants should be given if 
necessary. If the obstruction is persistent and threatens 
to cause suffocation, tracheotomy or intubation will have 
to be performed. The patient’s strength must be kept 
up by proper nourishment and stimulants. 

Should the patient appear to be suffocating, the nurse 
may, until the arrival of the physician, try to remove the 
membrane with a cotton-stick or with her finger; in fact, 
at such a time she will be justified in doing anything 
that will save the patient’s life. Calomel fumigation (PI. 
4) often affords relief from the urgent symptoms. 

Whooping- Cough.—Whooping cough (pertussis) be¬ 
gins with all the symptoms of catarrh of the trachea and 
bronchi (the air-passages), high temperature, and rapid 
pulse. About the tenth day the cough becomes vio¬ 
lent, the deep, loud, long-drawn, shrill inspirations which 
will be heard are probably due to spasmodic contraction 
of the glottis. During the attack the child may become 
perfectly blue; the veins in the neck become swollen, 
and in some cases will be thoroughly exhausted after 
coughing, while in others the child will rapidly recover 


NURSING IN SPECIAL MEDICAL DISEASES. 239 

and continue to play. The patient must be isolated from 
other children, and be given light and nourishing food; 
the air of the room must be kept pure and the temperature 
even. Steam inhalations and counter-irritants to the chest 
may be ordered. Anything that seems unusual about the 
child must be reported. Should convulsions occur, a 
warm bath should be given while waiting for the doctor, 
and cold cloths be applied to the head. The disease 
may last from four to six weeks, or even longer. The 
paroxysms of coughing occur oftener at night than dur¬ 
ing the day, and generally, where there are a number of 
children with the disease in the same room, when one 
begins to cough the others also begin. Among the 
complications are chronic bronchial catarrh, pneumonia, 
diarrhea, and phthisis. Whooping cough is very infec¬ 
tious through the discharges from the nose and throat. 

2. Functional and Idiopathic Diseases. 

Influenza (la grippe) is an acute infectious disease 
characterized by fever, pains in the head, back, and limbs, 
great prostration, chilliness, sneezing, hoarseness, and 
cough. 

The treatment is rest in bed and liquid diet. The pains 
in the head, chest, and limbs may be relieved with hot 
applications. Phenacetin, 5 grains in half an ounce of 
whisky every four hours, may be given. It must be 
remembered that phenacetin is very depressing on the 
action of the heart, and, though some persons can take 
doses of from 15 to 20 grains, death has been known 
to result from a smaller dose. This fact is mentioned 
because the drug is very carelessly used, no thought 
being given to its action on the heart; it should not be 
taken—in fact, no drug should be taken—without the 


240 


PRACTICAL POINTS IN NURSING. 


sanction or advice of a physician. The patient must 
be guarded against draughts, and be stimulated if the 
pulse indicates heart-failure. The complications are ca¬ 
tarrhal and croupous pneumonia, inflammation of the 
kidneys, and heart-failure. One attack does not mean 
immunity from another. 

Croupous Pneumonia.—Croupous pneumonia, which 
is acute inflammation of the proper substance of the lungs, 
is generally confined to one lung; when both lungs are 
involved it is called “ double pneumonia.” The disease 
usually begins suddenly with a chill or a chilly feeling 
which lasts a long time, high temperature (102 to 104° F.), 
pulse rapid and full (100 to 120 or above), sharp pain in 
one side, and the patient can breathe only with difficulty; 
consequently the respirations are quickened to thirty-five 
or forty per minute, they are shallow, and often irregular. 
There is a short dry cough, accompanied later by a rust- 
colored tenacious sputa, which must be kept for the 
doctor’s inspection. The bowels are constipated, and 
the urine is scanty and high-colored. Delirium is not 
uncommon. 

About the seventh or the ninth day there may be a 
sudden drop in the temperature, profuse perspiration, and 
a general improvement may take place, while in severe 
cases a sudden drop of temperature to subnormal, small, 
rapid pulse, coldness of extremities, and a blue appear¬ 
ance would indicate collapse, which must be met with 
stimulants and heat to the body and a mustard plaster 
over the heart. If the patient cannot swallow, the stim¬ 
ulants must be given per rectum. 

Until the arrival of a physician the nurse may apply 
to the chest flaxseed or mustard poultices or fomenta¬ 
tions. The room must be a sunny room, having an 


NURSING IN SPECIAL MEDICAL DISEASES. 241 

open fire if possible, and be kept well ventilated, free 
from draughts, and the temperature at yo° F.; if the 
perspiration is very profuse, the patient should be wiped 
dry with warm towels, and fresh clothing which has been 
well aired be put on. When the physician arrives he will 
give directions, which must faithfully be followed. He 
may order ice-bags or compresses, which will often give 
great relief, or hot poultices, which must be changed 
every two or three hours. Some physicians object to 
poultices on account of their weight and because of 
the frequent change fatiguing the patient, and prefer 
to envelop the chest in a cotton jacket, which can be 
removed gradually by cutting off from the bottom about 
2 inches each day. The cotton jacket is readily made by 
basting two layers of sheet cotton-wool inside an under¬ 
shirt. Oil silk is basted on the outside to prevent evap¬ 
oration of the moisture exhaled from the skin. When 
the temperature is very high, cold baths are given, 
which, besides reducing the fever, will quiet the respi¬ 
rations and soothe the patient. 

The diet must be liquid and nourishing—milk, broths, 
beef-juice, koumyss, egg-nog, wine whey, etc. The pa¬ 
tient must be kept in bed, perfectly quiet. The prostra¬ 
tion is often great, in which case there is danger of 
heart-failure. The disease reaches its height about the 
seventh or the ninth day. As the patient improves the 
diet is increased to soft solids—custards, puddings, cream 
toast, eggs, scraped-beef sandwiches—gradually prepar¬ 
ing the way for a more solid diet. Pneumonia is a self¬ 
limited disease; hence the nurse must do all in her 
power to support life until it has run its course. It is 
also infectious through the expectorations; the sputum- 
cup (Fig. 64), lined with paper, which can be taken out 
16 


242 PRACTICAL POINTS IN NURSING. 

and burned and the cup boiled about three times a day, 
should be used to receive the expectorations. 



Fig. 64.—Sputum-cup : a, the cup ; b, the paper lining. 


Bronchitis.—Bronchitis, which is an inflammation of 
the bronchial tubes, is caused by exposure to cold, es¬ 
pecially when the body has been overheated. It is also 
a complication of some of the infectious diseases—mea¬ 
sles, influenza, and typhoid fever. An acute attack begins 
with chilliness, a sore and tight feeling in the chest, in¬ 
creased by coughing, which at first is dry, but later is 
accompanied by a muco-purulent sputum, which becomes 
very profuse as convalescence sets in ; the temperature 
is 100 to ioi° F., with a corresponding increase of the 
pulse. Hot mustard poultices or fomentations must be 
applied to the chest, and hot drinks and hot mustard 
foot-baths be given. For the relief of the dyspnea, which 
is difficulty in breathing, the patient must be raised into 
the best breathing position possible and be given inhala¬ 
tions of steam. If the breathing is very difficult, the 
patient apparently dying from suffocation, an emetic 






































































NURSING IN SPECIAL MEDICAL DISEASES. 243 

should be given to expel the mucus from the tubes, and 
heat applied over the heart. 

The air of the room must be kept moist and the tem¬ 
perature even (70° F.). The diet should be liquid. The 
patient must be guarded from all draughts, the bowels 
be kept open, and stimulants be given if the pulse indi¬ 
cates heart-failure. 

Asthma also calls for heat over the heart and lungs, 
inhalations of steam, hot drinks, hot foot-baths, and 
plenty of fresh air. 

Pleurisy.—Pleurisy is inflammation of the pleura, the 
membrane covering the lungs. The symptoms are severe 
pain or “ stitch ” in the side, short, dry cough, and short¬ 
ness of breath, owing to the pain caused the patient in 
breathing. There may be little or no expectoration, and 
the cough may be suppressed on account of the pain 
the coughing gives the patient. Hot mustard fomenta¬ 
tions should be applied over the seat of the pain. If 
there be no mustard at hand, plain fomentations or 
a flaxseed poultice may be used; the patient should 
be propped up with pillows, thus making the breathing 
easier. 

If there is effusion of liquid into the pleural cavity, 
the amount of urine passed may be very small. The 
amount excreted must be measured and reported. An 
increase in the amount is a very good sign, as it shows 
that the effusion is being absorbed. The effusion into 
the cavity causes pressure upon the heart, the lungs, 
and other organs, which may be pushed out of place; 
paracentesis or tapping is then performed, and the 
amount of liquid drawn may vary from a pint to three 
quarts. 

Empyema.—Sometimes the collection of pus in the 


244 PRACTICAL POINTS IN NURSING. 

pleural cavity becomes purulent; then we have what is 
called “ empyema.” For this condition the pus is removed, 
and the pleural cavity is washed out with disinfectants, a 
drainage-tube is inserted, and an antiseptic dressing put 
on. In simple cases, when only a small opening is made 
with a large hypodermatic needle or a very small trocar, 
a piece of adhesive plaster or collodion dressing will be 
sufficient to cover the opening. The nurse of course 
prepares antiseptically for the operation. It is remark¬ 
able to see the great change for the better that takes 
place after the operation, providing there are no com¬ 
plications. 

The temperature must carefully be watched; its rise 
may indicate a fresh collection of pus in the cavity. 
In case of emergency, when the cavity has rapidly filled 
up and the patient is in danger of dying during the ab¬ 
sence of the physician, the nurse will be justified in draw¬ 
ing off some of the fluid, but it is generally well to ask 
the attending physician, if he lives at a distance and the 
nurse is distant from other medical aid, what he would 
like her to do in this emergency. 

Angina pectoris is neuralgia of the heart: the patient 
has severe pain around the heart and there is difficult 
breathing. Hot alcoholic stimulants should be given 
and heat applied over the heart. 

Gastritis, which is inflammation of the mucous mem¬ 
brane of the stomach, is often due to imperfect masti¬ 
cation of food, drinking liquid too hot or too cold, or 
drinking any of the corrosive or irritant poisons. 

The symptoms are severe pain and a burning sensation 
at the pit of the stomach, vomiting, the vomit being 
sometimes streaked with blood, intense thirst, small, 
rapid pulse, and all the symptoms of collapse. 


NURSING IN SPECIAL MEDICAL DISEASES. 245 

Treatment of Gastritis .—A physician must be sum¬ 
moned, and in the mean time the nurse can apply hot 
fomentations or a mustard plaster over the seat of pain. 
If it is known that a poison has been taken within 
a short time, she should try to wash out the stomach, 
which operation, in the absence of the stomach-pump, 
can easily be done by using a fountain syringe or by 
giving large quantities of warm water to drink until the 
gastric contents become clear. The patient must be fed 
by enemata, and the stomach be given absolute rest for a 
few days, unless otherwise ordered ; then the nurse should 
begin the feeding with a few drops of milk and lime-water, 
equal parts; if this is retained, she should gradually in¬ 
crease the dose and the interval between the doses. 
Crushed ice, ice-cream, iced champagne, or very cold 
Seltzer water, given in very small quantities, will often be 
retained. The patient should be fed slowly, and the diet 
gradually be worked up to egg-nog, oyster-broth, raw 
oysters, arrowroot, custards, etc., though the change of 
diet must not be made without the physician’s orders. 

Peritonitis is inflammation of the peritoneum, the 
serous membrane lining the abdomen. Peritonitis 
may be due to cold, to blows upon the abdomen, to 
inflammation of any of the organs in the abdomen 
covered by the peritoneum, or it may follow an opera¬ 
tion upon the abdomen. It may also occur in typhoid 
fever after perforation of the bowel, the contents of the 
latter escaping into the abdomen and the peritoneum 
becoming inflamed. There may be a chill, severe pain 
in the abdomen, which is distended and tender, vomit¬ 
ing, constipation, high temperature (from 101 to 103° 
F.), small, rapid pulse, and respiration high and shallow, 
owing to the pain caused by breathing. The expression 


246 PRACTICAL POINTS IN NURSING. 

of the face is drawn and anxious. The patient when in 
bed lies on the back with the knees drawn up, which 
position relaxes the muscles of the abdomen. A roll or 
a pillow placed under the knees will remove the strain 
that the patient has to make in order to keep up the 
knees. 

Treatment .—Poultices or fomentations are applied to 
the abdomen, and the weight of the bed-clothes re¬ 
lieved by a cradle. The nurse must not give purgatives 
on her own responsibility, as there is danger of irri¬ 
tating an already inflamed and tender membrane and 
causing perforation. When convalescence begins, the 
patient should be fed well with nourishing food, but re¬ 
turn to solids should not be made without the physician’s 
orders. The nurse will know at the end of a few days 
if the patient is to live or to die: if death is imminent, 
there will be loss of strength and collapse. 

If the peritonitis is the result of perforation of the 
bowel, as in typhoid fever, hot fomentations must be 
applied, the patient to be kept absolutely quiet, and the 
foot of the bed elevated. Gas-accumulation can be re¬ 
lieved by inserting a rectal tube. 

Appendicitis is inflammation of the vermiform appen¬ 
dix, the inflammation being sometimes due to the pres¬ 
ence in the appendix of foreign bodies, such as grape-, 
lemon-, orange-, or melon-seeds, or concretions of fecal 
matter; other causes are intestinal catarrh, a blow on 
the abdomen, unusual physical efforts, or cold. Ap¬ 
pendicitis is more common in men than in women for 
various reasons. Men work harder and are subject to 
more violence than women. The intestines may become 
inflamed through constipation or hard drinking, the in¬ 
flammation extending to the appendix. The appendix 


NURSING IN SPECIAL MEDICAL DISEASES. 247 

is supplied with blood from one artery, a branch of the 
mesenteric artery which supplies the cecum. Catarrhal 
appendicitis is generally caused by extension of catarrh 
of the cecum to the appendix. If an abscess forms, an 
operation is necessary or perforation may take place, re¬ 
sulting in septic peritonitis and death within a very few 
days. The operation is also considered in the catarrhal 
form, as the patient is always liable to recurrent attacks, 
each subsequent attack increasing the danger to life, that 
may result in perforation and general peritonitis. Per¬ 
foration is a dreaded complication caused by the rupture 
of an abscess into the peritoneal cavity. The symptoms 
of perforation are sudden pain, a small, wiry pulse, and 
subnormal temperature; or there may be a rise of tem¬ 
perature, and the distention of the abdomen may be 
increased. 

The symptoms of appendicitis are severe pain, swelling, 
and tenderness on the right side of the lower part of the 
abdomen, rise of temperature, constipation, and, later, 
vomiting. 

A patient ill with peritonitis lies in bed with both knees 
drawn up, and usually in appendicitis the same position 
is assumed, or the right knee alone may be drawn up. 

The treatment is medical and surgical. For a catar¬ 
rhal attack the treatment is absolute rest on the back, 
liquid diet, an ice-bag, or hot turpentine or mustard 
fomentations or poultices. The appendix is removed 
when there is an abscess and also in case of perfora¬ 
tion (unless the shock is too great). 

The writer here desires to impress upon the nurse the 
absolute necessity of perfect antisepsis for this opera¬ 
tion, as it can only be successful when she has obtained 
thorough surgical cleanliness. The source of infection 

o o 


248 


PRACTICAL POINTS IN NURSING. 


at all operations (not only when the abdominal cavity 
is to be opened) is often the hands of the surgeon, the 
assistant, or the nurse, and the instruments, sponges, and 
dressings; any fault or neglect on the part of the nurse, 
no matter how small, may cost the patient his life. 

The work of the nurse until the arrival of the surgeon, 
who must be summoned immediately, lies in securing for 
the patient perfect rest and quiet and the application of 
hot mustard or turpentine poultices or fomentations. 
The bowels must be moved with a soapsuds or an oil 
enema, gently and carefully given. When the surgeon 
arrives he will decide as to the line of treatment; if an 
operation is decided upon, everything must antisep- 
tically be prepared as nearly as possible under the 
existing circumstances. 

A question often asked is whether a nurse is justified 
in giving morphia before the arrival of medical aid. In 
the writer’s opinion a nurse is not justified in giving 
morphia when a physician is within easy reach, because 
it covers up the symptoms and the physician cannot 
judge the case; it may also stupefy the patient so that 
he cannot give clear answers to questions; but if she is 
distant from medical aid and the patient has severe pain, 
then she may give, hypodermatically if possible, J gr. of 
morphia, which will relieve the pain and vomiting. 

After a catarrhal attack, when the appendix has not 
been removed, the patient must be very careful with 
regard to diet and personal hygiene, and should wear 
a flannel abdominal protector, because sudden changes 
of temperature are liable to affect the bowels, which are 
very sensitive, and cause a recurrent attack. 

Dysentery is inflammation of the mucous membrane 
of the large intestine. The symptoms are chilliness, some 


NURSING IN SPECIAL MEDICAL DISEASES. 249 

fever, small and frequent movements from the bowels 
mixed with blood and mucus, and tenesmus, or constant 
straining and painful efforts to evacuate the bowels. Dys¬ 
entery begins with diarrhea, straining, griping pains in 
the abdomen, which is very tender, and the characteristic 
movements, which are very offensive and which must be 
thoroughly disinfected. 

Treatment .—The patient must be put to bed and use 
the bed-pan in his defecations; he must not be per¬ 
mitted to get up, as there is danger of ulceration, 
perforation of the intestine, and peritonitis. A cathar¬ 
tic of magnesia sulphate, 2 teaspoonsful, or 1 ounce 
of castor oil with 15 drops of laudanum, should be 
given to clear the bowels of the irritating substance; 
the laudanum will relieve the pain and the desire to 
stool. Hot turpentine or mustard poultices or fomenta¬ 
tions should be applied to the abdomen. 

The diet should be liquid—boiled milk, gruels of 
flour, corn-starch, or arrowroot. The bed- and body- 
linen must be kept perfectly clean and changed often. 
Dysentery is not contagious, but if the movements are 
not disinfected, they decompose and the epidemic form 
may result. 

Cholera morbus, which is inflammation of the mu¬ 
cous membrane of the stomach and intestine, is caused 
by irritating food, such as unripe or decayed fruit and 
vegetables, and also by sudden changes in temperature. 
There are severe cramps in the stomach and abdomen, 
violent vomiting and purging, the discharges later resem¬ 
bling rice-water; great prostration. 

Treatment .—Hot applications to the abdomen and 
body must be resorted to at once, and stimulants ad¬ 
ministered if necessary. Ice will relieve • the intense 


250 


PRACTICAL POINTS IN NURSING. 


thirst. A liquid diet must be given—milk, gruels, 
broths, and egg-nog. 

Acute Diarrhea.—In treating acute diarrhea the pa¬ 
tient must be put to bed and fed on liquid diet—boiled 
milk, corn-starch, rice and flour gruels, etc. A laxative of 
castor oil I ounce and laudanum 15 drops may be given 
to remove the irritant and relieve the pain. 

Uremia is caused by the retention in the blood of 
certain waste material, consisting chiefly of urea , which 
should have been eliminated by the kidneys; this reten¬ 
tion of urea gives rise to the disease called “ uremia.” 

Uremia may abruptly begin with convulsions, followed 
by coma, or there may be premonitory symptoms, some 
of which are headache, nausea, vomiting; scanty urine 
deficient in urea; dimness of vision; the mind dull, deep¬ 
ening into stupor, followed by coma. Sometimes covul- 
sions precede the coma, which terminates in death unless 
the poison causing the attack is rapidly eliminated. The 
pulse is slow and full; temperature subnormal. When 
the convulsions occur they may rapidly take place one 
after the other, the patient generally being unconscious 
between the attacks. The pulse during the convulsions 
may be found small and rapid, and the temperature be 
raised. 

The treatment must be prompt. If the nurse is far 
from medical aid, the first thing to be done is to put 
something between the patient’s teeth to prevent the 
tongue being bitten. The patient should then be given 
a hot pack or a hot-air bath, which will increase the 
activity of the skin and also act as a sedative; morphia 
(gr. J) should be given to stimulate the heart, induce 
perspiration, and secure rest and quiet. 

The bowels must be moved with salts or by an enema. 


NURSING IN SPECIAL MEDICAL DISEASES. 25 I 

The second convulsion can be controlled by giving a 
little ether if it is at hand; if not, then the hot bath 
should be repeated, hot drinks be given, heat applied 
over the kidneys and to the feet, cold to the head, and 
the morphia repeated every three hours if necessary. 
If the pulse is weak, heart stimulants should be admin¬ 
istered. Uremia may occur in scarlet fever, pregnancy, 
Bright’s disease, and in other diseases. 

Cerebro-spinal meningitis is an infectious disease 
beginning with a chill, very severe headache, pain in the 
muscles of the neck and back, that very soon become 
rigid, so that the head is bent backward and the back 
is straightened; the arms and legs are flexed; vomit¬ 
ing, delirium, and constipation are present; there may 
be intolerance of light and sound and deafness or blind¬ 
ness. After a few days a spotted rash may appear. 
The disease attains its height in a very few days, and 
the temperature may rise to 105 0 F. or higher, with 
convulsions, stupor, coma, and death, or the symptoms 
may gradually disappear and the case end in convales¬ 
cence. 

Treatment. —Ice-bags or ice poultices are applied to the 
back of the neck and spine, and it is a good plan to apply 
heat to the extremities to avoid any depressing effect from 
the cold. The diet must be liquid. If the patient can¬ 
not swallow, he must be fed by enemata, and the nurse 
should do all in her power to sustain life. Stimulants 
must be given if the pulse indicates heart-failure. 

Cerebral apoplexy, or cerebral hemorrhage, is caused 
by the bursting of a blood-vessel in the brain, which 
accident may be due to disease of the cerebral blood¬ 
vessels. The size of the clot varies, it may merely be a 
capillary oozing, or it may fill a hemisphere of the brain, 


252 PRACTICAL POINTS IN NURSING. 

and the amount of paralysis is generally due to the size 
of the clot. If the clot is small, the paralysis may be 
slight and finally disappear. 

The premonitory symptoms are headache, dizziness, 
languor, ringing in the ears, and a numb, weak feeling 
on the affected side, and there may be gradual paralysis 
without unconsciousness. 

If an attack comes on suddenly, the patient either falls 
back in his chair or to the ground unconscious; the face 
is flushed, the breathing stertorous, noisy, and slow, and 
the cheeks puff out at each breath; the pulse is slow and 
full, and the temperature subnormal, due to shock. The 
pupils may be unevenly contracted. 

Treatment .—The head and shoulders must be elevated, 
the clothing about the neck be loosened, ice applied to 
the head (particularly to the affected side), and heat to 
the feet and the body. The mucus must be wiped from 
the mouth and throat. There should be given a cathar¬ 
tic of croton oil, 2 drops in a little sweet oil or glycerin, 
dropped on the back of the tongue, where it will be ab¬ 
sorbed, and the bowels be emptied by enemata. Stimu¬ 
lants must not be given unless ordered by the doctor or 
unless the pulse is feeble, as they increase the hemor¬ 
rhage into the brain. To obtain involuntary swallowing 
the liquid or powder is placed far back on the tongue 
and the nostrils and lips are closed. 

The nurse must watch for convulsions, which may be 
tonic or clonic. A tonic convulsion is a stiffening of the 
muscles of the body without involuntary movements, 
while a clonic convulsion consists in involuntary move¬ 
ments of the body. As a convulsion may begin tonic, 
it is very important for the nurse to notice in what part 
of the body the convulsion begins, and if the pupils of 


NURSING IN SPECIAL MEDICAL DISEASES. 253 

the eyes change during the day, or if they remain dilated 
or contracted, or if they are unevenly contracted. 

If recovery takes place, the patient must have nourish¬ 
ing and easily digestible food. He will need the most 
careful nursing on account of the paralysis. The nurse 
should guard against bed-sores by keeping the patient 
and the bed perfectly dry and clean. The patient must 
be kept absolutely quiet and free from all mental excite¬ 
ment : another shock generally follows the first, as the 
blood-vessels of the brain are in a diseased condition. A 
certain amount of paralysis usually remains, according 
to the degree of severity of the case. One patient may 
recover consciousness, be thoroughly sensible of every¬ 
thing that is being said and done, but be totally unable 
to speak, this difficulty lying not with the muscles of 
the tongue, but in the brain. Another patient may be 
able to utter words, but unable to connect them so as 
to make himself intelligible. Because a patient is unable 
to speak it does not follow that he is also'deaf. Many 
times the hearing is very acute, the faintest whisper be¬ 
ing heard; hence the nurse must be very careful as to 
what she says when in the patient’s room. 

Differential Diagnosis .—As apoplexy is often mistaken 
for intoxication or for opium-poisoning when the patient 
is found in the street, it will be well for the nurse to re¬ 
member that in apoplexy there is unconsciousness, ster¬ 
torous breathing, and paralysis, the movements of the 
patient being confined to the sound side of the body; 
the pupils of the eyes may be found contracted or dilated 
or uneven. This contraction denotes irritation, and the 
dilatation denotes compression of the brain. In opium¬ 
poisoning the pupils are very narrowly contracted—the 
size of a pin’s head; there is unconsciousness, but no 


254 PRACTICAL POINTS IN NURSING. 

paralysis. In intoxication the pupils may be contracted 
or moderately dilated, dilating still more as the patient 
comes to his senses. The smell of alcohol on the breath 
is of no assistance in determining the condition of the 
patient, as spirituous liquor may have been given by the 
first person who found the unconscious patient. 

Paralysis.— Hemiplegia is paralysis of one side of the 
body; paraplegia is paralysis of the lower half of the 
body; and monoplegia is paralysis of one limb, such as 
an arm or a leg. By paralysis is meant total loss of 
power or motion and of sensation ; that is, the patient 
cannot move the part paralyzed because there is no 
power or motion in it, neither may there be any feel¬ 
ing or sensation. When the loss of power is only par¬ 
tial, this condition is called “ paresis.” It will be appro¬ 
priate to say here that the nerves have their seat in the 
brain, and at the base of the brain they cross from side 
to side ; those at the right side supply the left side of the 
body, and those at the left side supply the right side of 
the body, so when the right side of the brain is injured 
or diseased it is the left side of the body which is para¬ 
lyzed, and vice versa. 

The treatment of paralysis consists in good hygienic 
surroundings. Extreme cleanliness is necessary to pre¬ 
vent the formation of bed-sores. Massage and electri¬ 
city are employed, which in some cases have effected 
partial and even complete recovery. 

There is complete helplessness of patients in this class 
of cases ; they are totally dependent upon the nurse; 
they feel their helplessness very keenly, and also appre¬ 
ciate the kindness and cheerfulness with which the nurse 
does everything for them. 

Epilepsy.—Epilepsy is a disease of the nervous sys- 


NURSING IN SPECIAL MEDICAL DISEASES. 255 

tem. The attack may occur either with or without 
warning. The patient may fall to the ground entirely un¬ 
conscious, with a pale face and the breathing be almost 
stopped. After a few seconds this passive condition 
passes away and there follow convulsions, which cease 
after a few minutes, and the patient falls into a deep, 
heavy sleep, awakening without knowing what has hap¬ 
pened. The patient, however, may fall, remain uncon¬ 
scious, and recover in a few minutes. In the milder 

\ 

form the patient suddenly stands still or may pause in 
what she is doing, then recovers her senses and continue 
her work. After the severe attack there generally re¬ 
main headache, despondency, and a very tired feeling. 

Some patients have the attacks only in the daytime, 
while others have them at night. Some patients, again, 
can tell when an attack is coming on, and by doing cer¬ 
tain things can ward it off, as, for instance, by rubbing the 
part where the sensation is first felt, or if the thumbs or 
toes turn in by straightening them out. This sensation 
is called the “ aura epilepticathat is, the sensation 
which sometimes comes before an epileptic fit and by 
which the patient can tell when the fit is coming on. 

The treatment of epilepsy lies in first putting something 
between the patient’s teeth to prevent the tongue being 
bitten; then in loosening the clothing about the neck 
and chest, and in not restraining the patient unless the 
body movements are excessive, in which case the arms 
and legs are grasped and the movements followed. One 
can thus keep the patient from hurting herself or others. 

The nurse must notice the eyes—are they fixed ? are 
the pupils dilated ?—the color of the face, and on which 
side the convulsions began, and whether the unconscious¬ 
ness is complete or partial. Epileptic cases should never 


256 


PRACTICAL POINTS IN NURSING. 


be left alone, but should be watched day and night, as a 
fit of temporary insanity may take the place of convul¬ 
sions and the patient may injure herself or others. 

The' patient must be kept free from all mental and 
physical excitement, and take plenty of exercise in the 
open air. The diet may chiefly be vegetable. A free 
action of the bowels should be secured each day. 

Hysteria is very often mistaken for epilepsy, though 
one can generally recognize hysteria by noticing that 
the patient takes care not to hurt herself; she cannot 
bear the eyeball to be touched; there is no grinding 
of the teeth nor biting of the tongue, nor the complete 
unconsciousness found in epilepsy. There are different 
forms of hysteria, from simple fits of laughing, crying, 
and screaming, and imagining all sorts of ills and ail¬ 
ments, to hysterical convulsions, paralysis, and insanity. 
In dealing with this class of patients, and indeed with all 
nervous patients, the nurse needs an ample amount of 
patience, tact, and firmness. A strict watch must be 
kept over such patients; they are very skilful in deceiv¬ 
ing their attendants ; frequently morphia and other things 
received from friends are hidden in the bed and taken 
when the nurse is attending to other duties. Various 
treatments are prescribed for the simple form, from a 
cold bath to an emetic, the patient being under the im¬ 
pression that she is taking morphia; the violent vomiting 
and retching that ensue cure both the hysteria and the 
morphin habit, but moral suasion must be tried first. 

In some cases there is also complete loss of sensation 
in certain parts of the body, while in other cases there 
is pain in the head, stomach, abdomen, and limbs. This 
pain is not imaginary to the patient; to her it is very 
real and calls for treatment. Through love for sym- 


NURSING IN SPECIAL MEDICAL DISEASES. 2$J 

pathy, however, the patient will pretend to have pain 
when she has none, and when her attention is drawn 
to other things the pain will vanish. 

It is the same with hysterical paralysis: the patient 
really believes that she is paralyzed and cannot walk. 
Encouragement does a very great deal for this imaginary 
condition, and frequently patients will gradually improve 
if encouraged to walk, and the paralysis will disappear 
in a very short time. All excitement must carefully be 
avoided, and hysteria must never be mentioned before 
the patient. Globus hystericus is a feeling of choking, a 
sensation as of a ball rising in the throat. 

Neurasthenia is nervous prostration brought on by 
overwork and study and by other causes. Moral treat¬ 
ment is of as much importance here as in hysteria, with 
the exception that one cannot sympathize with an hyster¬ 
ical patient, while a patient ill with neurasthenia requires 
sympathy, together with the firmness, kindness, and en¬ 
couragement that are used in hysteria. 

The treatment of nervous prostration and also of the 
severe forms of hysteria is known as the rest cure, which 
is complete isolation from family and friends and perfect 
rest of mind and body. The patient is allowed to see no one 
but the physician and nurse, since the presence of friends 
requires conversation and mental effort. Absolute rest in 
bed is necessary. The food must be nourishing, easily 
digestible, and given at regular intervals. Massage and 
electricity are employed to take the place of active exer¬ 
cise. For the treatment to be successful the rules laid 
down by the physician must be faithfully carried out. 

Dropsy is an unnatural collection of fluid in the tis¬ 
sues or the cavities of the body. Cardiac dropsy usually 
begins in the feet and ascends. 


17 


258 PRACTICAL POINTS IN NURSING. 

Diabetes is of two kinds— diabetes mellitus, charac¬ 
terized by the presence of grape-sugar in the urine, and 
diabetes insipidus, characterized by the excretion of a 
very large quantity of pale urine of a low specific gravity, 
and generally free from albumin and sugar. In diabetes 
mellitus the urine is increased in quantity. Sometimes 
the amount passed in the twenty-four hours is very large, 
from 2 to 6 quarts; the specific gravity of the urine 
ranges from 1015 to 1050. 

Nursing. —The diet should be restricted in this dis¬ 
ease ; everything containing starch or sugar being 
omitted, saccharin and glycerin being substituted. It 
will be the nurse’s duty to keep an accurate account 
of the amount and frequency of urine passed, and also 
to see that only the diet ordered by the physician is 
given. 

Rheumatism.— Acute articidar rheumatism is cha¬ 
racterized by inflammation of the joints. There is also 
high temperature (103 to 104° F., and sometimes higher) 
profuse acid perspiration, pain, tenderness, and swelling 
of the affected joints. 

Nursing. —The bed should be made up with blankets, 
and a flannel bed-gown be worn by the patient, for the 
reason that sheets and gowns of muslin become very 
wet and cold with the perspiration. The utmost gen¬ 
tleness must be observed when changing the bed- and 
body-linen or when changing the position of the patient, 
because of the extreme pain. 

The room must be kept of even temperature (68° F.), 
and the patient be guarded against all draughts, the 
affected joints being wrapped in cotton batting. The 
diet should consist of milk, soups, egg-nog, etc. and the 
thirst relieved with lime- or lemon-juice. 


NURSING IN SPECIAL MEDICAL DISEASES. 259 

The medicinal treatment is generally salol, salicylic 
acid, and salicylate of sodium to relieve the pain and 
reduce the temperature. When giving the salicylates 
the nurse must watch for the physiological effects, which 
are noises in the ears, deafness, nausea, vomiting, perspi¬ 
ration, and delirium. The fever may be controlled by 
the cold pack or cold bath, or bathing with tepid water. 
Massage and electricity are often employed. 

The pain may move from joint to joint, or may affect 
only one joint. When only one joint is affected, it is 
called “ monoarticular ” rheumatism, and if more than 
one joint, it is called “polyarthritis.” As there is great 
danger of heart-failure, the patient must not be allowed 
to rise from the bed without permission from the doctor. 
Severe cases of the disease may develop cerebral symp¬ 
toms : there will be restlessness, delirium, very high tem¬ 
perature, with a small, rapid pulse, pale and rather blue 
face, convulsions, and death. 

Acute muscular rheumatism is an affection of one or 
of a group of muscles. The disease may repeatedly 
occur in the same patient; therefore one attack does 
not mean immunity from another; there is always a 
tendency to the disease. Its treatment is similar to that 
of acute articular rheumatism. Cold and dampness must 
carefully be avoided, and the patient should wear woollen 
garments next the skin. 

Diseases of the Skin. —A few words on skin diseases 
will close these medical discussions. 

Eczema is an inflammatory disease of the skin, and of 
it there are many varieties. It is often due to irritation 
through using hard soaps and to putting the hands in 
certain fluids. 

Scabies, or the itch , which is contagious, may be ac- 


26 o 


PRACTICAL POINTS IN NURSING. 


quired by shaking hands with a person thus affected or 
by touching anything that she has used. There is an 
intense itching of the hands between the fingers, of the 
axilla, and of the inner part of the thighs, that grad¬ 
ually spreads over the body. It is worse when the 
patient is warm, and especially when she is in bed. 

Ringworm is also contagious; a child thus infected 
should be isolated from other children. 

Herpes zoster, or shingles , is often due to debility, 
to damp clothing, and exposure to cold. 

Treatment of Skin Diseases .—The treatments of all 
skin diseases differ very much, each case being treated 
according to the method of the physician in charge. 
The utmost cleanliness with regard to the patient and 
nurse is necessary, many skin diseases being infectious. 

Ointments are generally ordered for all the above- 
described cases, as they exclude the air and are very 
soothing. The nurse must be very careful to guard 
against infection, and to wash and disinfect her hands 
thoroughly after attending the patient, who must also 
be kept perfectly clean. Some of the skin diseases are 
very difficult to take care of; others, again, are almost 
disgusting in their character, and it is very hard for some 
nurses to conceal their feelings when dressing the parts ; 
the patient, too, is often very irritable. All this calls for 
a great amount of patience, kindness, and sympathy on 
the part of the nurse, who must try to hide her emo¬ 
tions when doing the dressings, for the patients are very 
sensitive and narrowly watch her face. We have here a 
noble example in the Sisters of Charity, who, as was 
said by Dr. Myles Standish, “ with kindness in their 
manner, gentle care in their hands, and the love of 
God in their hearts and souls, could care for and dress 


NURSING IN SPECIAL MEDICAL DISEASES. 261 

without expression of loathing and disgust the gangrene 
then so often seen in the surgical wards, and the most 
loathsome disease. All honor to them! They taught 
the world, both physician and the layman, the value 
of nursing.” 

Caring for the dead is one of the duties the nurse will 
have to perform. The writer need hardly admonish the 
nurse to be very sure that the last sacraments are re¬ 
ceived, 1 and that the friends be notified before the patient 
becomes unconscious. The nurse should remain with 
the patient to the end, and not let her die alone. 

When the end has come the following instructions 
should be followed: Straighten the limbs, close the eyes 
by pressing the lids down with the fingers, and then 
leave the room to the family for a while. After the 
family have left the room the bed-clothes must be re¬ 
moved and a fresh under-sheet put on the bed; take 
away all pillows but one. Wash the body with soap and 
water and some disinfectant, and guard it against expo¬ 
sure the same as if the body were conscious. The rec¬ 
tum and vagina must be packed with cotton of any kind 
to prevent discharges. Sometimes it is necessary to 
pack the mouth and nostrils for the same reason. Put 
a napkin, drawers, under-vest, night-gown, and stockings 
on the body. Comb and dress the hair in the way that 
it was usually worn by the patient. Arrange the lips 
and prop up the jaw with a roll; do not bandage, as this 
will wrinkle the skin, it being desirable to have the face 
look as life-like as possible. Clean the nails. 

If there are wounds on the body, they must have a 
fresh dressing put on; wounds about the head can be 

1 The nurse should see that all her patients, Catholic or Protestant, 
receive the last sacraments before death. 


262 PRACTICAL POINTS IN NURSING. 

covered with a small cap made of black silk. Tie the 
limbs with a bandage and cover the body with a sheet. 
Put the room in perfect order and remove all signs of 
the illness. If the case has been contagious, the body 
must be washed with disinfectants and be wrapped in a 
sheet wrung out of the same; the funeral must be pri¬ 
vate and the room afterward fumigated (see p. 234). 


VI. THE NURSING OF SICK CHILDREN. 

Care of the New-born.—The sudden contact with 
the outer air is generally a shock to a new-born infant. 
The temperature of the room should be 76° F. for the 
first week, and the temperature of the water for the bath 
be 98° F. Everything should be made ready before be¬ 
ginning to bathe the baby. It should be wrapped in a 
blanket and one part at a time be bathed without the aid 
of soap. The body then is thoroughly oiled to remove 
the cheesy substance called “ vernix caseosa ” which 
protects the skin of the child while in the womb. 

The nurse will find this cheesy substance very thick 
upon the scalp, and if not removed it may cause inflam¬ 
mation ; indeed, it may cause inflammation if allowed to 
remain on any part of the body. After the body has been 
thoroughly greased, it must be washed with soap and 
water, care being taken that the soap does not enter the 
eyes. White castile is the best soap; it is the least irri¬ 
tating. The babe should be thoroughly dried and pow¬ 
dered with corn-starch, which is about the best powder 
to use for an infant unless the nurse can have talcum 
powder. Some physicians do not want the baby to have 
a soap-and-water bath after the oiling, but simply to have 



THE NURSING OF SICK CHILDREN 263 

the oil wiped off and the baby dressed. The body of 
the babe should be examined to see that it is perfectly 
normal; any abnormality must be reported. The flan¬ 
nel used in giving the first bath should be burned. 

Dressing the Cord .—The navel cord is dressed by 
wrapping it in sterilized gauze or antiseptic cotton, the 
binder put on, and the cord placed on the left side of the 
body, because if placed on the right side it would press 
upon the liver, which at birth is larger than the other 
organs, and which reaches down to the navel. The 
binder must not be pinned too tight or the gas cannot 
pass through the intestines. 

Dressing the Infant .—The clothing of the new-born 
consists of a shirt, a diaper, socks, and a flannel slip, 
which, made after the manner of the muslin slip, fastens 
in front and extends from 8 to 10 inches below the feet. 
Over this comes the muslin slip, made about 2 inches 
longer than the flannel one. These slips afford warmth 
and lightness and also looseness, so that the body can 
expand, the body not being bound by bands about the 
abdomen and chest, as when the old-fashioned skirts 
were worn; the first of these skirts was generally pinned 
so tightly about the abdomen that the gas could not 
escape from the bowels, and the child had colic; the 
skirt was also brought up over the child’s feet, so that 
they could not be moved. The second skirt was pinned 
so tightly around the chest that the chest could not ex¬ 
pand. Taking the old method of dressing all together, 
the child was so uncomfortable that it cried a good deal, 
and every cause was thought of except that of the cloth¬ 
ing being pinned too tight. 

These two garments or slips can be put one within 
the other and both put on at once. In summer-time the 


264 


PRACTICAL POINTS IN NURSING. 


waist of the flannel slip may be made of muslin, and the 
skirt be attached to it. All the garments are fastened 
with small pearl buttons, and if instead of flannel there 
is provided an elastic knitted-wool binder, which is slip¬ 
ped on over the feet, there will be needed only one 
safety-pin, and that for the diaper. 

After the dressing the baby is laid in the crib or a 
clothes-basket, covered lightly, and the eyes shaded 
from the light. A baby should sleep during the first 
few days twenty hours out of the twenty-four, and will 
do so if it is left alone and not taken up for exhibition 
or to be rocked, or carried about, all of which tends to 
keep the child in a perpetual state of excitement, thus 
making it nervous. 

Bathing the Baby .—Until the cord separates, which 
should be on the fourth or fifth day, the infant should be 
given a sponge-bath every morning, and after the separa¬ 
tion a tub-bath. The temperature of the water must be 
98° F., tested with a bath-thermometer. The child must 
be lowered gently into the water. The head is supported 
with the left hand and the body washed with the right. 
After five minutes the child is taken out, laid on a warm 
blanket, and thoroughly and gently dried. The skin 
must be kept well powdered, especially in the folds, as 
it is very sensitive and the air and water act as an irri¬ 
tant. If there is chafing, the chafed parts should be 
covered with soft linen. 

Defecation and Urination .—The first bowel movements 
of a baby are dark, almost black ; if cloths are placed in¬ 
side the diaper, they can be burned. This color of the 
feces gradually changes to a bright yellow, which is the 
normal color; any departure from this condition shows 
that something is wrong and it must be reported, and 


THE NURSING OF SICK CHILDREN 265 


also if the baby passes urine. Owing to the absence 
of coloring matter in the infant’s urine, whereby it 
will not stain the diaper, and the small amount voided 
at the frequent urinations, it is often supposed that 
there is some obstruction. Close and frequent exami¬ 
nation will clear up the condition. The diapers must 
be changed as soon as wet, and the parts bathed and 
powdered. 

Nursing of the Infant .—The baby should be put to 
the breast regularly every two hours during the day, 
and only when it awakes during the night. It should 
suckle about fifteen minutes. A baby’s stomach holds 
only about I ounce. Feeble babies must be fed oftener 
day and night. The mouth must be washed before 
and after each feeding with water to which has been 
added a little borax. 

When the baby cries the nurse should find out the 
trouble. Very often the trouble is some little thing, 
such as being thirsty, which a little clear cold water will 
relieve. The infant must not be put to the breast unless 
it is time. Babies get tired of lying in the one position; 
they cannot turn themselves, and they waken and cry; 
therefore their position should be changed by taking 
hold of the clothing at the shoulders and limbs, and 
gently turning them; they will not awaken, and besides 
making them more comfortable the change will lengthen 
their sleep. 

Artificial Feeding .—If the baby must be brought up by 
hand (bottle feeding), the physician will direct the cha¬ 
racter of the food to be given and the nurse must faith¬ 
fully carry out his orders. At times the food consists of 
equal parts of milk and water until after the first month, 
when the water is gradually diminished, until at the fifth 


266 


PRACTICAL POINTS IN NURSING. 


or sixth month, when the milk is given plain. If the 
milk seems to disagree with the infant, a teaspoonful 
of lime-water added may correct the trouble. The bot¬ 
tles and nipples, and the vessels in which they are 
washed, must all be kept perfectly clean. The rubber 
nipples must be cleansed inside and out, and should be 
boiled for about ten minutes before being used, and be 
kept in cold water during the intervals of feeding. The 
bottles should be scalded inside and then filled with cold 
water to which is added about a teaspoonful of baking- 
soda. 

Milk Sterilization .—If it is required to sterilize the 
milk, sufficient should be sterilized to last twenty-four 
hours, and enough be put in each bottle for a single 
feeding. The mouths of the bottles should be stoppered 
with absorbent cotton, which will absorb the germs of 

the air and keep them away from 
the milk. The best apparatus for 
sterilizing milk is the Arnold ster¬ 
ilizer (Fig. 65). In the absence 
of this sterilizer the bottles can 
be placed in an ordinary boiler 
of cold water either on sticks or 
on a folded towel to keep them 
from touching the bottom of the 
vessel, the water reaching to the 
necks of the bottles. The water 
should come to a boil, then the 
boiler cover be put on, and the 
boiler removed from the fire, and 
left to steam for about one hour, 
after which time the bottles are taken out and put away 
in a cool place. The bottles must not be opened until 



Fig. 65.—Arnold sterilizer. 

























THE NURSING OF SICK CHILDREN. 2 67 

needed. A bottle of the milk should be warmed by 
allowing it to stand a few minutes in a pan of hot water; 
the cotton is then taken out and the rubber nipple put 
on. If any of the milk is left in the bottle, it must be 
thrown away. Sterilizing the milk renders it free from 
germs. Pasteurization is the preferable method. 

Infant Food and Rides for Feeding. —Dr. Meigs’ food 
is the favorite with some physicians. It consists of— 

2 tablespoonsful of cream, 

1 “ of milk, 

2 “ of lime-water, 

3 “ of sugar-water. 

Sugar-water is made by adding 8 teaspoonsful of sugar 

of milk to 1 pint of water. Lime-water must be added 
to the milk after sterilizing, not before, because in boiling 
it chemically changes and discolors the milk. 


General Rides for Feeding ( Rotch ). 


Age. 

Intervals 

of 

feeding. 

Number of 
feedings in 

24 hours. 

Average 
amount at 
each feeding. 

Average 
amount in 

24 hours. 

1st week. 

2 hours. 

IO 

i ounce. 

10 ounces. 

1-6 weeks. 

2 x / 2 hours. 

8 

i X -2 ounces. 

12-16 ounces. 

6-12 weeks 
and possibly 
to 6th month. 

3 hours. 

6 

3-4 ounces. 

18-24 ounces. 

At 6 months. 

3 hours. 

6 

6 ounces. 

36 ounces. 

At 10 months. 

3 hours. 

5 

8 ounces. 

40 ounces. 


At the time of feeding the baby must be taken on the 
nurse’s lap, and it must not be allowed to doze over its 





































268 


PRACTICAL POINTS IN NURSING. 


meal; the baby, however, must not be hurried; the 
bottle should be taken away when the meal is over, and 
on no account should the child suck from an empty 
bottle. As the baby grows the intervals between the 
feedings are lengthened and the amount of food is in¬ 
creased. At seven months the baby may have milk 
slightly thickened with good bread or well-boiled oat¬ 
meal once or twice during the day; at ten months a 
little meat-broth made with barley or rice, without vege¬ 
tables ; at twelve months it should be weaned. The baby 
must have no solid animal food until after the second 
year, and even during the second year milk should be its 
chief food. It must not be given tea, pastry, stimulants, 
fruit, cheese, or soothing syrups, or any medicine without 
proper medical advice. 

Infant Development .—At the third week the baby may 
be taken out doors for its first airing, being carried in the 
arms, not in a carriage, and with its head supported. A 
baby will hold up its head at from three to five months, 
will quickly recognize objects at from six to eight months, 
will sit alone at from the seventh to the eighth month, 
will walk at from the ninth to the twelfth month, will ut¬ 
ter single words about the first year, and will begin to talk 
by the second year. A baby does not shed tears until 
the second or the third month of age, and if very sick at 
eight months the tears do not flow until convalescence 
sets in. The teeth begin to grow between the fourth and 
the seventh month. The anterior fontanclle —that is, the 
middle opening in the top of the head—rather increases 
in size during the ninth and twelfth months, and then de¬ 
creases, and should be closed at eighteen months. The 
baby must not be allowed to stand alone before twelve 
months; the leg bones are not very strong and they 


THE NURSING OF SICK CHILDREN. 


269 


may bend; when sitting up its head and neck should be 
supported. A baby should gradually increase in weight, 
after the second day, from 3 to 5 ounces each week. It 
loses weight during the first two days. 

The temperature at birth is 99 0 F., pulse from 130 to 
140 beats, respirations from 40 to 46 per minute. The 
temperature is usually normal after the first week. 

Care of Premature Infants.—A premature baby is 
one born before full term; it is usually put in an incu¬ 
bator (Fig. 66), which supplies the infant with artificial 



Fig. 66.—Modified Auvard incubator or couveuse : a, glass plate of the movable lid 
(3); c y ventilating tube containing small rotary fan ; k, ventilating slide ; m, hot-water 
cans ; o, slide closing hot-air chamber. 


body-heat until it reaches its full time. An incubator 
may be improvised out of a large wooden box by having 
one side so arranged that it will slide in and out; the top 
is also arranged to allow a piece of glass to be inserted and 
to slide in and out. Across the middle of this box are 
nailed three wooden strips, which will divide the box into 
two compartments, the lower one for the heaters, hot- 
water bottles or hot bricks, etc., the upper one being 



























































2 JO PRACTICAL POINTS IN NURSING. 

fitted with flannel or with cotton for the baby. The glass 
cover is kept open about half an inch at the foot of the 
box, to allow entrance of fresh air to the infant. A ther¬ 
mometer is also placed in the upper compartment, and 
an even temperature of 86° F. should be kept. When 
the baby is taken out to be changed or bathed the glass 
cover is drawn back : when the heaters are to be re¬ 
newed the sliding side is drawn back. If a box cannot 
be procured, then the baby should be wrapped in cotton 
and be kept in a basket near the fire. The temperature 
of the water for the bath must be ioo° F.; the tempera¬ 
ture of the room should be from 80 to 86° F., and the air 
be kept fresh and pure. 

If brought up by hand, the baby is wrapped in cotton . 
and flannel so arranged that the napkin can be changed 
without disturbing the baby, which must only be taken 
out of the incubator to nurse. Should the attending 
physician not allow the mother to nurse the infant, it 
should be fed every hour during the day with about two 
teaspoonsful of the mother’s milk, given by means of a 
medicine-dropper. 

Diseases of Infancy.— Thrush is a disease caused by 
decomposition of food in the mouth of the child, and is 
characterized by small white spots on the tongue, the 
sides of the mouth, and the gums, that may spread to 
the throat and stomach. To prevent this disease, the 
mouth should be thoroughly washed after each feeding 
with water to which has been added a little borax. 
Should the disease appear, wash the mouth every two 
hours with borax-water (about 15 grains to 1 ounce of 
water). 

Colic is relieved by the application of hot fomentations 
to the abdomen, and internally 1 teaspoonful of anise-seed 


THE NURSING OF SICK CHILDREN. 


271 


tea every ten minutes until three doses have been taken; 
or plain water may be used should the tea not be at 
hand. Colic is due to cold or to the accumulation of 
gas in the bowels, and it generally yields to heat. The 
child lies with the knees drawn up, its cries are sharp, 
long, and loud, and they die away as the pain is re¬ 
lieved. 

If the food does not digest well, the movements will 
be green, and in them there will be curds of milk. This 
condition must promptly be reported to the physician. 
Lime-water or baking-soda (about half a teaspoonful 
added to the milk) will often correct the indigestion ; the 
white of an egg well beaten up and added to about 6 
teaspoonsful of cold water and a little sugar-water will 
also give the stomach a rest for a few days from milk 
digestion, besides being nourishing. If the baby is nurs¬ 
ing, give half a teaspoonful of lime-water to the same 
amount of water before putting the child to the breast. 

Bozvel Obstruction .—Blood in the movements and con¬ 
stipation may be due to obstruction of the bowel. The 
child screams with pain; the abdomen is distended and 
tender; there is vomiting; the respiration is difficult, and 
there may possibly be convulsions. Until the arrival of 
the physician hot fomentations may be applied over the 
abdomen and a soapsuds enema given. To give the enema , 
everything must first be prepared and laid on a chair or a 
table near by; the nurse takes the baby on her lap, and 
lays it on its left side, with the knees drawn up. The 
tube, which for a very small baby should be the smallest 
tube that comes with the syringe, should be oiled, the 
air expelled, and the tube inserted in the rectum and the 
bulb gently squeezed. Pressure is applied over the 
rectum to retain the enema for a short time. 


272 PRACTICAL POINTS IN NURSING. 

Diarrhea. —In diarrhea the bowel-movements will be 
found acid, and sour-smelling, and will contain particles 
of undigested food ; their color will be green. The baby 
has, besides the frequent movements, griping pains in the 
abdomen, vomiting, and restlessness. Diarrhea is often 
caused by improper feeding and changes in the temper¬ 
ature during the hot summer months. The extreme heat 
depresses the system and leaves it susceptible to the 
slightest change. 

The treatment of diarrhea lies in getting rid of the irri¬ 
tation, by giving either an enema of half a teaspoonful of 
castor oil in hot, sweetened milk, or in the same amount 
of glycerin or of hot coffee. The baby should be kept 
in bed and be given for a few days, instead of milk, the 
white of an egg well beaten and added to an equal 
amount of cold water and a little sugar. When the 
vomiting is persistent the stomach is to be washed out. 
A small rubber catheter, with a funnel attached to one 
end, is used, and the washing is done in the same man¬ 
ner as that for an adult (see p. 70). 

Vomiting may be caused by over-feeding, when the 
milk will be returned clear because the stomach cannot 
hold the amount ingested. This condition is not serious ; 
but when the milk is returned curdled and sour, it is due 
to indigestion or it may be a symptom of some disease. 

Cholera infantum begins with vomiting and diarrhea, 
weak, rapid pulse, and symptoms of lowered vitality and 
collapse. 

Treatment consists of high starch-and-laudanum ene- 
mata to check the movements. Heat must be applied to 
the body or the child may be put in a hot bath (temp, of 
105° F.). The food for a while is generally white of egg 
with 4 drops of brandy, alternated with 10 drops of Val- 


THE NURSING OF SICK CHILDREN 


273 


entine’s or expressed beef until the appearance of undi¬ 
gested food is removed from the bowel movements. The 
air of the room must be kept pure and fresh. When the 
child is strong enough to be taken out, it should be kept 
outdoors the greater part of the day. Cholera infantum 
is caused by impure air and improper food and exposure 
to heat. 

Rickets , which is also due to improper food and impure 
air, is a disease of the bones owing to an insufficient amount 
of inorganic matter in the bones, that makes them soft, so 
that they easily bend. The child is restless when asleep, 
throwing off the bed-clothes ; when awake it is fretful and 
irritable, and cannot bear to be touched; the abdomen is 
distended ; the head is large; the anterior fontanelle (the 
middle opening in the top of the head) is found open at 
the time when it should be closed—that is, at about 
eighteen months; the teeth are late in appearing; there 
may be hydrocephalus (dropsy of the brain); and the 
long bones of the legs are so bent that the child is 
knock-kneed. There are other symptoms, all caused 
by the want of proper nutrition, and the child presents a 
sickly, puny appearance. 

The treatment of rickets lies in nourishing food, perfect 
cleanliness, pure, fresh air, and massage, and in not allow¬ 
ing the child to walk, to stand, or to sit until its bones 
are strong enough to bear the weight of the body. 
Many cases of knock-knee are caused by the child be¬ 
ing allowed to walk or to stand before the bones of 
the legs are strong. 

Convulsions may be due to indigestion, pin-worms, 
etc., or to brain-excitement in rickets, or to irritation of 
the nerve-centres in teething. A great number of the 
diseases of children are ushered in with convulsions. 


18 


274 


PRACTICAL POINTS IN NURSING. 


which take the place of the initial chill in the adult. 
They may come on suddenly or gradually. 

Treatment .—The first thing for the nurse to do is to 
put the child into a hot bath (the temperature about from 
ioo to 104° F.), without waiting to undress it, which can 
be done in the water. The head should be kept raised 
and cold applied to it. The hot-water bath will dilate 
the blood-vessels of the body, thus diverting the blood 
from the brain to the body. If the attack is the begin¬ 
ning of any of the eruptive diseases, the heat will also 
bring out the rash, besides relieving any pain in the 
abdomen or elsewhere. The baby is to be kept in the 
bath about five minutes, and is then taken out and 
wrapped in a warm blanket; an enema is given to clear 
the bowels. A physician should be summoned. 

Teething , which usually begins about the seventh 
month, may be accompanied by many disturbances, such 
as diarrhea, indigestion, convulsions, all of which should 
receive attention. 

Worms .—Delicate children are often troubled with 
worms, which are of three kinds—thread-worms, round- 
worms, and tape-worms. The first two are the most 
common. The symptoms are numerous: itching and 
rubbing of the nose and external parts, vomiting, rest¬ 
lessness, grating the teeth during sleep, convulsions, 
etc.; but we must wait until the worms are seen in the 
movements before attributing to them any of these 
symptoms. The worms are generally found in the 
lower bowel, and are passed in the movements, though 
sometimes they are vomited. The bowels should be 
thoroughly cleared by giving the child a dose of castor 
oil, followed by an enema of salt and water, and these 
measures continued daily until the worms have all been 


THE NURSING OF SICK CHILDREN 275 

passed, no more being seen in the movements. The 
expulsion of a tape-worm belongs to the physician. 

Protrusion of the bowel may be remedied by placing 
the child on its back and elevating its buttocks. The 
parts should be washed with tepid water and the bowel 
replaced, then a pad or compress wrung out of ice-water 
be applied, and kept in place with a napkin. If this 
treatment does not succeed, a physician should be sum¬ 
moned. Protrusion is often caused by constipation and 
the straining efforts of the baby. A baby should be 
taught regular habits, which, with a little patience, can 
be established. 

Ophthalmia neonatorum is an inflammation of the 
conjunctiva, which is one of the coats of the eye¬ 
ball. It is a very serious variety of ophthalmia, gen¬ 
erally caused by infection during birth from the ma¬ 
ternal discharges. In this case the fault usually lies 
entirely with the nurse in not cleansing the eyes 
immediately after the head is born, and also in not 
washing the baby’s hands, because in this way any 
mucus on its hands is rubbed into the eyes ; it is also 
caused by using the same cloth and water for washing 
the eyes that have been used for the body. Any red¬ 
ness of the eyes or the eyelids must promptly be re¬ 
ported. If cold compresses are ordered, they must be 
changed every two minutes. 

Syringing the eyes is best done with a medicine-drop¬ 
per. The dropper is filled with the ordered solution, which 
may be of boric acid: in applying the solution it should 
flow from the outer to the inner corner of the eye, thence 
to a piece of cotton or of compress. The eye must be 
kept perfectly clean, and all pieces of cotton or compress 
used about it must be burned. Ophthalmia is a germ 


276 


PRACTICAL POINTS IN NURSING. 


disease and is highly contagious. If the nurse has to 
touch the eyes with any solution, she should twist a 
piece of absorbent cotton around the end of a tooth¬ 
pick or a match-stick, a fresh piece being used for each 
eye, these eye-swabs being burned immediately after¬ 
ward. These cases are very fatiguing, but the baby’s 
sight depends upon the faithfulness with which the phy¬ 
sician’s orders are carried out. Many cases of blindness 
are due to neglect. The nurse must protect herself by 
not touching her face, eyes, or hair unless her hands 
have been thoroughly washed and disinfected. Every¬ 
thing employed about the eye or eyes must be burned, 
and on no account be used about other parts of the body. 

Snuffles , or cold in the head, may be relieved by keep¬ 
ing the baby warm, oiling the outside of the nose, and 
keeping the nostrils clear by cleaning them with a small 
piece of cotton twisted around a match-stick. 

Infant paralysis is recognized by the baby having no 
power over its limbs. Sometimes the affection is ushered 
in with convulsions and a high fever, and vomiting, then 
follows a wasting of one or more muscles. The limb is 
at first tender, and the baby may cry when it is touched. 
The baby must be kept warm, good nourishing food be 
given, and massage and electricity applied. 

Tongue-tie .—Sometimes the band beneath the baby’s 
tongue is too short and the baby cannot nurse. It is 
then tongue-tied , and the band will have to be snipped. 
This is a simple and almost painless operation, taking only 
a very few minutes, and no anesthetic is required, neither 
is there any loss of blood. The nurse can see the baby’s 
tongue by placing a little sugar on the lower lip of the baby; 
this will cause it to put out the tongue to get the sugar. 

The temperature of babies and that of some of the 


THE NURSING OF SICK CHILDREN. 277 

older children must be taken in the rectum, the ther¬ 
mometer being oiled before it is inserted, and carefully 
watched lest any sudden movement of the child should 
break the thermometer, the mercury and fine glass 
entering the rectum. The baby should be placed on 
its left side on the nurse’s lap. 

Pulse and Respiration .— The pulse can only be taken 
correctly when the baby is asleep. The pulse is very 
easily affected, the least thing sending it up, together 
with the temperature, and increasing the respirations. 
The pulse at birth is about 140 beats per minute, and 
gradually it decreases with increase in age, as follows: 


First month the pulse is about.120 

First to second year it is about. no 

Second to fifth “ “ “ 100 

Fifth to eighth “ “ “ 90 

Respirations at birth are from.40-50 

First month, about.40 

First to third year, about.35 

Third to fifth “ “ .• • • 25 


Signification of the Baby's Cry .—Until the child be¬ 
gins to talk its cry is its only language. If the cry is 
long and persistent it is usually due to hunger, or the 
child has earache, in which case the hand is drawn up 
to the ear. If there is pain in the head, the hand is 
also drawn up to the head and the cry is sharp and 
piercing, the face flushed, and there is restlessness. 
With pain in the abdomen the cry is long, sharp, and 
loud, and gradually ceases as the pain subsides. The 
knees are drawn up to the abdomen. If the pain is in 
the chest, the cry is sharp and suppressed, with the 
cough which accompanies it; the nostrils dilate and 
contract. 










278 


PRACTICAL POINTS IN NURSING. 


Diseases of Childhood.—Any of the diseases which 
attack grown persons may also attack children. 

Typhoid fever is apt to run a milder course in children 
than in adults ; the nursing, however, is just the same. A 
strict watch must be kept of the temperature for'hemor¬ 
rhage, which is indicated by a sudden drop of tempera¬ 
ture and a weak, rapid pulse. The bowel-movements 
after the hemorrhage are dark red, but if the feces are 
not passed for some time after, they resemble tar. The 
child must be kept perfectly quiet (not allowed to move), 
so that the blood will coagulate in the blood-vessels and 
prevent further hemorrhage. Cold water or crushed ice 
may be given in small quantities; only the amount of 
water or ice it is intended the child to have should be 
put into the tumbler; if there is more and the tumbler is 
taken away, the child will cry for it. Baths and packs 
are given in the usual manner. Ice can be applied to 
the head by crushing the ice and making an ice poul¬ 
tice which can be stitched upon a night-cap. This will 
prevent the poultice falling from side to side. In the 
absence of rubber there may be used flannel or towels, 
which are fastened to the pillow, so that the weight of 
the poultice will not be on the child’s head. 

With children ulceration of the bowels is less likely 
than with adults, consequently the dangers of hemor¬ 
rhage and perforation are less. The rash may be absent, 
but the brain-symptoms are marked and generally the 
temperature rises suddenly. 

Meningitis is inflammation of the membranes of the 
brain. 

Symptoms .—The child is restless, listless, drowsy, and 
fretful; loses flesh ; grinds the teeth when asleep, and 
the pain in the head causes him to wake up with a 


THE NURSING OF SICK CHILDREN. 

scream ; he cannot tolerate the light or the slightest noise; 
the pulse is increased and the temperature is raised. These 
symptoms deepen ; the drowsiness increases, followed by 
delirium. The pupils of the eyes may be dilated or evenly 
contracted, or the child may squint; there may be convul¬ 
sions. Finally there is complete coma. 

The treatment of meningitis lies in keeping the child 
perfectly quiet in a darkened room and in applying cold 
constantly to the head. The bowels must be kept open 
and the child be fed by the rectum if necessary. The 
child must be kept perfectly clean. As the stupor sets 
in the urine and the excreta will involuntarily be passed. 

Mumps is an inflammation of one or both of the par¬ 
otid glands, situated beneath the ears. There are fever¬ 
ishness, headache, restlessness, chill, and vomiting, and 
then the swelling begins. The disease is both conta¬ 
gious and infectious, and for this reason an affected child 
must be isolated from other children. 

Treatment. —The child must be kept warm and hot 
fomentations applied to relieve the pain, or the neck and 
face may be covered with absorbent cotton or flannel. 
Oil rubbed into the skin will relieve the tight feeling. 
After four or five days the swelling begins to subside 
and the pain is relieved. Soft food should be given. 

Incontinence of urine needs the care of a physician, as 
it may be due to some trouble with the bladder, or the 
urine may contain too much acid. Children who have 
this trouble are very often whipped and scolded by both 
parents and nurses : this is a great mistake, and is wrong 
to a child, unless the nurse is sure that the incontinence 
is due to carelessness. 

Chorea , or St. Vitus' dance , is a nervous disease of 
childhood, and is characterized by the involuntary 


28 o 


PRACTICAL POINTS IN NURSING. 


twitching of one or more or of all the muscles of the 
body, that ceases when the child is asleep. In mild 
cases recovery takes place in from four to six weeks; 
but in severe cases, when the whole body is involved, the 
child may die, either through inability to take nourishment 
or to sleep, or from heart complications. The affected 
child must be isolated from other children or they will 
imitate its affliction. Good nourishing food must be 
given, and the child be kept free from all excitement. 
Rheumatism being one of the complications of chorea, 
any stiffness of the joints must be reported. The child 
must be treated very kindly and gently spoken to; a 
sharp word has been known to throw a child into con¬ 
vulsions. Should convulsions set in without any appa¬ 
rent cause, such as fear, worry, or excitement, they may 
be the beginning of some complication. In severe cases 
of chorea the patients are kept in.bed. There is always 
the liability to recurrent attacks, and women who have 
had an attack in childhood may have a recurrence of 
the disease during pregnancy. 

Surgical Diseases of Children.—The surgical dis¬ 
eases of children are similar to those of adults, and 
demand the same treatment. After any trouble with 
the bowels, such as peritonitis or appendicitis, the child 
should wear a flannel abdominal binder, because sud¬ 
den changes in the temperature are liable to affect the 
bowels; the binder will keep the bowels warm and 
guard against recurrent attacks; the bowels must also 
be kept open. Pain in the knees or the hips must be 
reported; it may denote hip disease. 

Hip-joint disease (Coxalgia) is caused by a blow or a 
fall, or it may originate from tubercular inflammation of 
the structure of the hip-joint or scrofula, the patient in- 


THE NURSING OF SICK CHILDREN. 281 

heriting either of these diseases. The germ lodges in the 
end of the femur or thigh-bone. If the disease is of 
tubercular origin, tubercular meningitis may set in. The 
child must be confined to bed; he must not sit up. 
Every little while he will scream in his sleep on ac¬ 
count of pain caused by a muscular spasm which brings 
the inflamed surfaces of the joint together. Any knock- 
ing against or jarring of the bed causes great pain. 

Children must have plenty of fresh air and sunlight; 
they cannot live healthfully without; also good nourish¬ 
ing food, of which milk should be the chief. 

Nurse’s Management of Children.—A child who has 
been used to home-training and to having every whim 
satisfied does not take kindly to the nurse, and often 
will not allow her to do anything for him. Therefore, 
it is generally well for the child to see the nurse in 
the room for a little while, the mother acting under her 
directions, and after he has become accustomed to the 
nurse’s presence the way will be much easier. If the 
first thing the nurse has to do is to dress a painful 
part, she should not go up to the child and begin the 
dressing, but she should talk to him about his play¬ 
things ; then, after a while, with a little tact, she can look 
at the part, touching it very gently; if this causes no 
pain and the child thinks the nurse is not going to hurt 
him, he will let her do the dressing, the nurse all the time 
keeping up the conversation to attract his attention to 
other things. With children the nurse should be firm 
and at the same time be gentle; she should letmean 
yes, and no mean no. If the nurse has difficulty with a 
child at first, he will see that she is firm and that her 
orders are to be carried out. On no account must the 
child be deceived. A child will often take the most dis- 


282 


PRACTICAL POINTS IN NURSING. 


agreeable medicine from a nurse whom he loves and by 
whom he has never been deceived, because she says that 
it is easy to take, the patient having a child-like faith in 
her, when no power nor persuasion could make him take 
it from a nurse who was unkind or who has deceived him. 

Children live in the present, the past is soon forgot¬ 
ten. We should encourage their little efforts to be good, 
provide them amusement, and sympathize with them in 
their little troubles. A little boy (about four years old) 
went into his father’s study holding up a finger which 
had been pinched by the door, and, with a look of pain 
on his face, said, “ Look, papa, how I have hurt my fin¬ 
ger.” His father, who was busy writing and did not 
want to be interrupted, said rather impatiently, “ I can’t 
help it, dear.” The little fellow’s eyes filled with tears, 
and as he turned to leave the room he said in a low 
tone, “ You might have said ‘ Oh J ’ ” Children live in a 
world of their own ; their little trials are just as great 
to them as are our greater ones to us, for “ there is no 
misery like the misery of childhooda little sympathy 
for a pinched finger or a stubbed toe, a bumped head, a 
smashed doll or toy, is always a great comfort to them. 

In conclusion the writer begs to remind the nurse of 
what has been said about sympathy and kindness to her 
patients. They are so dependent upon her for comfort 
and sympathy that a gentle word or a pleasant smile, 
kind attention to their needs, and regard for their feel¬ 
ings, though little things, give great consolation. Sym¬ 
pathy and comfort are especially necessary before an 
operation, of which all patients naturally have a dread. 
None can realize what the feelings of the patients must 
be as they go bravely (outwardly) to the etherizing 
room, or what a comfort it must be to them to know 


THE NURSING OF SICK CHILDREN 283 

that some one who fully sympathizes is with them. It 
is here that they want their own to be with them, and it 
is here by kindness and sympathy that the nurse can, in 
a measure, take the place of their own. “ The small 
kindnesses,” says M. A. Kelty, “ the small courtesies, 
the small considerations habitually practised, the sympa¬ 
thy in our every-day work, give a greater charm to the 
character than the display of great talents and accom¬ 
plishments ; ” and in Felix Holt , George Eliot says : “ A 
supreme love, a motive that gives a sublime rhythm to 
a woman’s life, and exalts habit into partnership with the 
soul’s highest needs, is not to be had where and how 
she wills : to know that high initiation, she must often 
tread where it is hard to tread and feel the chill air and 
watch through darkness. It is not true that love makes 
all things easy; it makes us choose what is difficult.” 




ANATOMY 


Plate 5 



Anatomy of the Thorax and Abdomen: a, the thyroid ; b, the trachea ; c, c x , the first ribs ; 
d, d*, the clavicle (cut); G, arch of the aorta; g x , descending aorta; h, h x , right and left 
bronchi; i, esophagus; k, vena azygos; l, thoracic duct; m, m x , seventh ribs; n, diaphragm in 
section ; o, cardiac orifice of the stomach ; f, liver in section, showing orifices of hepatic veins; r, 
inferior vena cava; s, gall-bladder; t, pyloric end of stomach, joining t x , the duodenum; u, the 
spleen ; v, the pancreas ; w, the sigmoid flexure of colon ; x, caput coli (cecum); z, coils of the small 
intestine; 2, the innominate artery; 3, right subclavian artery; 4, common carotid artery; 5, left 
subclavian artery; 6, left common carotid artery; 7, left axillary artery; 8, superior mesenteric 
artery ; 9, left kidney (Maclise). 










PHYSIOL OGY AND DESCRIPTIVE ANA TOMY. 285 


PHYSIOLOGY AND DESCRIPTIVE 

ANATOMY. 

I. Physiology. 

Blood-circulation.—The circulation of the blood 
through all the parts of the body, taking with it the mate¬ 
rial for nutrition and gathering up the waste material, is 
caused by the action of the heart, the arteries, the capil- 



Fig. 67.—The heart. 


laries, and the veins. The arteries carry the blood from 
the heart, and contain pure, rich red blood. The aorta , 
the largest artery leading from the heart, branches off 
into smaller arteries, which finally become very small, 
and which are termed capillaries. These vessels are 






















































286 


PRACTICAL POINTS IN NURSING. 



very tiny, yet they allow a constant stream of blood to 
pass through them; they are very numerous and near 
the surface of the body, so that in pricking the finger we 
get an oozing of blood which comes from the capillaries. 
The capillaries connect with 
the veins , which at first are 
very small, but they grow 
larger and larger until they 
merge into two large veins, 
the vena cava superior and 
the vena cava inferior, which 
bring the blood back to the 
heart, and which are on the 8 
right side of the heart. 


Fig. 68. —Orifices of the heart, seen from 
above, both the auricles and the great vessels 
being removed (Huxley) : PA, pulmonary ar¬ 
tery and its semilunar valves ; AO, aorta and 
its valves ; PA V, tricuspid, and LA V, bicus¬ 
pid valves; MV, segments of mitral valve; 
LV, segment of tricuspid valve. 


Fig. 69.—Left auricle and ventricle, 
opened and part of their walls removed 
to show their cavities (Allen Thomson): 
1, right pulmonary vein cut short; i, 
cavity of left auricle; 3, 3', thick wall 
of left ventricle; 4, portion of the same 
with papillary muscle attached; 5, the 
other papillary muscles; 6, 6', the seg¬ 
ments of the mitral valve; 7 in aorta is 
placed over the semilunar valves; 8, 
pulmonary artery; 10, aorta and its 
branches. 


The Heart: its Structure and Valves. —The heart is a 
pear-shaped organ (Fig. 67), situated in the front of the 




PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 287 

chest, with its apex, or the small end, pointing down and 
to the left. This important muscular organ has two dis¬ 
tinct parts, each of which is again divided into two parts 
connected with each other. Each of these four parts, or 
chambers, holds about 2 ounces; the two upper cham¬ 
bers are called “ auricles,” the two lower “ ventricles ” 
(Fig. 69). There are openings between the right and 
left auricles and ventricles guarded by valves; the one 
between the right auricle and ventricle is the tricuspid 
valve; that between the left auricle and ventricle is the 
mitral valve (Fig. 68). There are two other valves, one 
in the right ventricle, where the pulmonary artery be¬ 
gins, the other in the left ventricle, where the aorta be¬ 
gins. These valves are called “ semilunar valves ” (Fig. 
68), and the object of these valves is to prevent the blood 
flowing back when the heart dilates. 

Mechanism and Course of the Circulation. —To return 
to the two great veins. The venous blood, which is 
loaded with impurities and is dark colored, reaches the 
two great veins, the vena cava superior and the vena 
cava inferior, which join together and empty into the 
right auricle; this chamber contracts and forces the 
blood down through the tricuspid valve into the right 
ventricle, which contracts and sends the blood through 
the right semilunar valve and pidmonary artery into the 
lungs. In the lungs the blood throws off its impurities, 
takes up a new supply of oxygen, and becomes pure, 
bright-red arterial blood. This change is due to the 
respiration. This pure blood returns to the heart by the 
pidmonary veins , which empty into the left auricle; this 
contracts and forces the blood down through the mitral 
valve into the left ventricle, which also contracts, and 
sends the blood through the left semilunar valve into the 


288 


PRACTICAL POINTS IN NURSING. 


aorta, which is the largest artery in the body. The first 
branch of the aorta is the coronary artery, which sup¬ 
plies the heart itself. The branches of the aorta are 
many, and they grow smaller and smaller as the distance 
from the heart increases, carrying the pure blood to all 
parts of the body; the last of these branches are the 
capillaries, which are so small that they are invisible to 
the naked eye. The blood, when passing through the 
capillaries, loses its bright-red color and becomes dark, 
because the different tissues take from the blood what is 
necessary for their support, and give in return the waste, 
worn-out material; the oxygen disappears from the 
blood to a great extent, and the blood on reaching the 
veins becomes dark blue, being full of impurities. The 
blood then returns to the heart and thence to the lungs, 
where its* impurities are thrown off with the breath. 
The blood takes up a new supply of oxygen in the 
lungs, and repeats its journey through the body. 

There is one instance where the arteries carry venous 
blood, and the veins carry arterial blood ; it occurs in the 
pulmonary circulation , generally called the “ lesser ” cir¬ 
culation. In this circulation the venous blood enters 
the right auricle and ventricle, and passes through the 
semilunar valves into the pulmonary artery, thence to the 
lungs, where, as we have seen, it is purified and made 
into bright-red arterial blood, and returns to the heart 
by the pulmonary vein. 

There is another circulation, called the “ portal ” cir¬ 
culation, in which four large veins—the inferior and su¬ 
perior mesenteric, splenic, and gastric—form one large 
trunk called the “ vena portae.” This portal vein collects 
the blood from the stomach, the pancreas, the spleen, 
and the intestines, and carries it to the liver, where it 


PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 289 

mixes with the blood that is supplied to the liver. The 
blood then passes from the capillaries of the liver into 
small veins, the hepatic veins , which carry it to the vena 
cava inferior. 

The greater or systematic circulation begins at the left 
ventricle, thence through the aorta, and is distributed to 
all parts of the body, going through capillaries and veins, 
and then returning to the right auricle. 

Respiration.—The air we breathe is mainly composed 
of two gases, oxygen and nitrogen, there being more 
oxygen than nitrogen. The oxygen is absolutely neces¬ 
sary to support life; still, alone it would not support life, 
because it is too stimulating; hence there can be danger 
from too much as from too little oxygen. The nitrogen 
serves to dilute the oxygen. There is also a small quan¬ 
tity of carbonic-acid gas, which is very poisonous, and a 
certain amount of watery vapor, which, when exhaled, is 
invisible, except in cold weather, when it is seen to issue 
from the mouth or the nostrils in the form of a white 
cloud. 

Mechanism of Respiration .—Each time we breathe the 
air passes into the lungs through the nose, mouth, 
larynx, and trachea, thence to the bronchial tubes and 
air-cells of the lungs. The muscles of the chest ex¬ 
pand, the diaphragm contracts, allowing the lungs plenty 
of room to expand, the ribs are lifted, the lungs expand, 
the air-cells open, and a fresh supply of oxygen is in¬ 
haled. This action is called “inspiration.” The second 
movement is called “ expiration,” in which the diaphragm 
relaxes and rises in the form of a dome, the ribs descend, 
the chest contracts, the lungs, which are elastic, shrink, 
and the impure air is driven out. We breathe in oxy¬ 
gen and give out carbonic-acid gas, which must not be 
19 


290 


PRACTICAL POINTS IN NURSING. 


inhaled again, and to which there is a faint odor, but un- 
noticeable except when present in large quantity. 

Upon entering a poorly-ventilated hall or a room in 
which there are many people, one will at once notice 
the bad air. It is due to the carbonic-acid gas expired 
by each inmate, there being not enough oxygen to purify 
the air. Lighted gas-jets also consume the oxygen. 

If there is too little oxygen to purify the blood, the 
venous blood is distributed to the heart and thence to the 
body, and there is a feeling of faintness and suffocation. 

Our bodies must be supplied with fresh air, food, and 
drink ; we cannot live without them. One knows the 
need of food by the cravings of the stomach, the need of 
water by the dryness of the mouth and throat, the need 
of pure air by the feeling of suffocation. 

Animals, like human beings, take in oxygen and give 
out carbonic acid. Plants take in carbonic-acid gas and 
give off oxygen in the day-time; in the night they take 
in oxygen and give off carbonic-acid gas. It is for this 
reason that plants should be removed from a room at 
night. 

Besides the lungs, the skin and the kidneys assist in 
removing impurities from the body. 

The Digestion.—The organs of digestion are the sali- 
vary glands, the stomach, the liver, the pancreas, and the 
intestines. These so change the food we eat that it can 
be taken into the blood and nourish the body. 

The alimentary canal (Fig. 70) is about 30 feet long; 
it begins with the mouth and ends with the rectum. It 
is in this canal that the process of digestion is carried on. 
The first part, which extends from the mouth to the 
stomach, is called the “esophagus” (gullet), and con¬ 
ducts the food to the stomach. The stomach is the most 


niYSIOL OG V AND DESCRIPTIVE ANA TOM V. 2g I 


expanded part of the canal; its left end is enlarged, 
and because it is on the heart side of the body is called 
the “ cardiac dilatation.” The right end of the stomach 
narrows and connects with the 
small intestine. The small in¬ 
testine is a continuation of the 
canal, is about 20 feet long, and 
lies in convolutions in the abdo¬ 
men ; it ends in the large intes¬ 
tine, which is about 5 feet long, 
and which runs up the right side 
of the body (ascending colon), 
crosses over under the liver and 
stomach (transverse colon), de¬ 
scending the left side (descending 
colon), and ends in the sigmoid 
flexure and rectum (Fig. 70). 

Mastication and Deglutition .— 

The food when taken into the 
mouth is cut and ground by the 
teeth, reduced to a fine pulp, and 
mixed with the saliva, which 
changes the starch that the food 
contains into sugar by its active 
principle, ptyalin. When suffi¬ 
ciently masticated the food is carried backward to the 
opening which leads into the pharynx, and is thrust 
into the latter, the soft palate being lifted and its pillars 
brought together, while the backward movement of the 
tongue causes the epiglottis to incline backward and 
downward over the glottis, thus forming a lid over 
which the food can travel without dropping into the 
air-passages. The epiglottis prevents the food from 



Vermiform 

appendix 


ANUS 


Fig. 70.—The alimentary canal. 






292 


PRACTICAL POINTS IN NURSING. 


passing into the trachea, and the soft palate keeps it 
from passing into the nasal cavities. 

Stomach and Intestinal Digestion. —When the food 
passes into the stomach it is rolled about and thor¬ 
oughly mixed with the gastric jirice until it is reduced 
to the consistency of pea-soup, called “ chyme.” It then 
passes through the pylorus (a narrow opening at the 
right end of the stomach), and the duodenum, the first 
part of the small intestine adjoining the stomach. A 
large quantity of the fluid (chyme) is absorbed through 
the walls of the stomach and joins the blood-circulation. 
When the food or chyme passes into the duodenum it is 
mixed with the pancreatic juice and the bile , and is con¬ 
verted into chyle , a milky fluid formed by the digestion 
in the intestines of fatty particles of food. After passing 
through the small intestines the food gradually loses its 
nourishing properties, and finally enters the large intes¬ 
tine, where it acquires its characteristic fecal odor and 
color. 

Secretions. —Some of the secretions of the body are: 
saliva, perspiration, sebaceous matter, tears, gastric juice, 
pancreatic juice, intestinal juice, milk, bile, and mucus. 

In the mouth is the saliva -[ ^ atci \ which changes 

l Ptyalin / 


starch into grape-sugar. 

In the stomach is the gastric juice—water, pepsin, hy¬ 
drochloric acid—which digests albuminoids. 

In the intestines are the juices of the intestines—bile, 
pancreatic juice, water—which digest fats, starch, and 
albuminoids. 

Parotid Glands. —The parotid glands are situated one 
in front of each ear. They are salivary glands. 


PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 293 

Excretions. —The excretions are eliminated from the 
body by the skin, the lungs, the kidneys, and the bowels. 

Urinary Organs.—The urinary organs are the kid¬ 
neys, the ureters, the bladder, and the urethra (see page 
308). The kidneys purify the blood by removing from 
it waste and worn-out material. They also regulate 
the amount of water to be removed from the body, and 
the amount to be retained in the body for resorption. 

The Urine. —The urine is one of the excretions of the 
body, and contains waste and worn-out material held 
in solution, or “ salts,” as they are called, among which 
is urea, uric acid, urates, chlorids, and earthy phosphates. 

The normal quantity of urine passed in the twenty- 
four hours is from 30 to 50 ounces. The color is a light 
amber, the reaction acid, and the specific gravity (by 
which is meant the weight of the urine) averages from 
1018 to 1024, or may be as high as 1030 without there 
being any disease. There is a characteristic aromatic odor. 

The amount of urine is varied at different times, 
more being passed during the day than 
the night. Food and drink increase the 
quantity. After profuse perspiration the 
amount is decreased; while, on the con¬ 
trary, cold decreases the activity of the 
skin, and consequently the flow of urine 
is increased. Some diseases are charac¬ 
terized by an increase or a decrease in 
the amount passed; as, for instance, one 
of the first symptoms of diabetes melli- 
tus is the increased amount of urine 
passed daily, which amount may be as 
high as 80 or 100 ounces, of a specific 
gravity ranging from 1020 to 1045, which may indicate 




















294 


PRACTICAL POINTS IN NURSING. 


an abnormal amount of sugar in the urine, and the color 
may be a clear light yellow, without any sediment. 

When there is an excess of sugar or urea, or of any of 
the other substances in the urine, it does not follow that 
the kidneys are diseased; they may be perfectly healthy, 
and the change be due to some nutritive or other dis¬ 
turbance; but when we find albumin in the urine, the 
kidneys are generally diseased. 

In acute diseases the quantity of urine may be dimin¬ 
ished and its color and specific gravity be high. When 
convalescence sets in the amount increases and the spe¬ 
cific gravity may be found below the normal. 

The odor of the urine is affected by taking certain 
foods and medicines. 

The color of the urine varies from a light amber to a 
dark red (PI. 6). In nervous diseases the urine is very 
often pale, like water. In fever cases it is a high red color, 
and is generally thick and loaded with sediment, because, 
as the amount of food taken into the body is much less, 
the wasting process is more active; hence the amount of 
solids in the urine is increased. Medicines influence the 
color. Bile may give to it a dark-brown or a greenish 
color, as will also carbolic acid; iodoform will give to it 
a dark smoky color. 

The reaction for the twenty-four-hour amount is acid. 
After meals it may be neutral or alkaline. The reaction 
is taken with blue litmus-paper, which, if the urine is 
acid, will be turned red. If the urine is alkaline, it will 
turn red litmus-paper .blue, and if it is neutral (neither 
acid nor alkaline), it will have no effect upon either red 
or blue litmus-paper. 

The specific gravity of urine is taken with the urinom- 
eter (Fig. 71). When taking the specific gravity the 


URINE. 


Plate 6. 


i. 

PALE YELLOW. 


ii. 

LIGHT YELLOW. 


hi. 

YELLOW. 



IV. 

REDDISH YELLOW. 


v. 

YELLOWISH RED. 


VI. 

RED. 


VII. 

BROWNISH RED. 


VIII. 

REDDISH BROWN. 

IX. 

BROWNISH BLACK. 


Scale of Urinary Colors, according to Vogel (Wolff). 







































i 




i 


hr; "*l- 




W ■ V 








PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 295 

urine is poured into the tall glass and in the middle is 
dropped the urinometer, the number of degrees being 
read from off the scale at the level at which it rests. 

Tests of Urine .—To test for albumin a test-tube is 
half filled with urine and heat applied until boiling 
occurs. If albumin is present, the urine appears cloudy, 
and this cloudiness does not disappear on the addi¬ 
tion of a few drops of nitric or acetic acid. Another 
ready way, if nitric acid is at hand, is to pour some 
of the acid into a small glass, incline the glass, and 
pour down the side of it an equal amount of the clear 
urine, which will spread over the acid; if albumin is 
present, there will be a sharp white ring between the 
urine and the nitric acid. Very often we get this white 
ring when the mixed urates are present, and it might be 
mistaken for albumin ; but if urates are present and not 
albumin, the white ring, or “ zone,” as it is called, will 
not appear where the urine and nitric acid meet, but 
higher up, and later will spread into the urine, and if it 
is heated will disappear. When normal urine is poured 
on nitric acid a brown ring appears between the urine 
and the acid, due to the action of the acid on the color¬ 
ing matters. Hence, when there is an abundance of 
coloring matter the albumin precipitates may be simi¬ 
larly colored. 

A pretty test for sugar is to add to the urine an equal 
amount of sodii hydrate, which will make the urine 
alkaline, then add drop by drop a solution of sulphate 
of copper; if sugar is present, the mixture turns a dark 
navy-blue color. If this mixture is boiled, there will re¬ 
sult a reddish-yellow precipitate; this is Trommer’s test. 
Another test is to take urine and liquor potassae equal 
parts, and add a little bismuth subnitrate; this solution 


296 practical points in nursing. 

when shaken and boiled, if sugar is present, will turn 
perfectly black. 

2. Descriptive Anatomy. 

The anatomy of the body will not minutely be con¬ 
sidered, but merely a brief description of the skin, the 
muscles, and the bones, and the situation of the different 
organs of the body will be given. 

1. Skin.—The skin is the covering (integument) of the 
body that protects the parts beneath it, and that regulates 
the heat of, and gives off waste material from, the body. 
There are two layers of skin—an outer layer, the epider¬ 
mis , and an inner layer, the cutis (derma) or true skin. 
The latter is supplied with capillaries and nerves, and 
bleeds freely if cut or pricked. The epidermis does not 
bleed. Just below the cutis is a layer containing fat and 
the larger arteries of the body. On some parts of the 
body the skin is thicker than on others, as the palms of 
the hands and soles of the feet, while in other parts, the 
mouth, nose, rectum, etc., the skin apparently ends, 
which is not the case; it is only very much thinner, 
having two layers as before, the inner layer (endothe¬ 
lium) containing blood-vessels and nerves; the outer 
layer, which is similar to the epidermis, is called the “ epi¬ 
thelium.” The black color of the skin in the negro and 
the tawny color among some of the white races are due 
to the presence of pigment in the cells of the cuticle. 
Developed from the skin are the hair and the nails. 

2. Bones of the Body.—The bones are the frame¬ 
work of the body ; they afford protection to the important 
organs, and are covered with a fibrous membrane called 
the “ periosteum.” There are in the body about 206 
bones of different shapes and lengths. They are divided 


ANATOMY. 


Plate 7. 


Frontal bone. 


Orbit.—- 


Inferior maxilla. 

Cervical vertebrae. 

Scapula. 


Humerus.-- 


Lumbar vertebrae.- 


Ilium.-- 


-—Ilium. 



Parietal bone. 


-Temporal bone. 


-— Clavicle. 


Ulna. 

Radius. 


Carpus. 

Metacarpus. 


Phalanges.— 


Femur.--- 


-Patella. 


Tibia.- 

Fibula. 


^ Tarsus. 

^ . Metatarsus. 
^Phalanges. 


The Human Male Skeleton. 















PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 29 J 

into three groups—bones of the head, of the trunk, and 
of the extremities (PL 7). The femur or thigh-bone is 
the largest, longest, and strongest bone in the body, and 
the stapes (one of the little bones of the ear) is the small¬ 
est bone in the body. 

The ends of bones, when jointed movably with others, 
are covered with cartilage, having within the joint free 
surfaces of great smoothness, which surfaces are lubri¬ 
cated by the synovial fluid "secreted from the synovial 
membrane which lines the joints. The bones are further 
held together by fibrous tissue in the form of ligaments. 

Bones of the Skull .—The skull is a box of bone con¬ 
taining the brain, which is a soft, pulpy substance and is 
the chief organ of the nervous system. The skull is 
composed of two plates of bone from which the brain is 
separated a little distance. 

The thickest part of the skull is at the back, where it 
is half an inch thick, and the thinnest part is at the tem¬ 
ples. Just above the eyes on the forehead the two plates 
of bone are separated half an inch or more, so that when 
a person is kicked by a horse or otherwise injured, the 
outer table may be indented to a considerable extent, 
and it may even affect the inner plate without injuring 
the brain. 

Bones of the Trunk: Thorax .—The thorax, or chest, 
is bounded by the ribs, the breast-bone, and the back¬ 
bone. The chest contains the heart and the lungs, and 
also the large blood-vessels. 

There are twenty-four ribs (twelve on each side), of 
which the seven upper ones are called “ true ribsthe 
five lower are “ false ribs.” All the ribs are attached to 
the spinal column by ligaments and cartilage, which hold 
them in position. The seven true ribs are connected 


298 PRACTICAL POINTS IN NURSING. 

with the sternum (breast-bone) by means of fibrous 
bands. The 8th, 9th, and 10th ribs are each attached to 
the lower border of the rib above it. The nth and 12th 
ribs are called “ floating ribs,” having only one attach¬ 
ment, that of the spinal column. The sternum is the 
breast-bone. The clavicle , or collar-bone, is a long bone 
which articulates with the sternum and scapula. The 
clavicle connects the upper extremity, which is divided 
into shoulder, arm, forearm, and hand, with the body. 
The scapula , or shoulder-blade, is a large, flat, triangular 
bone held in place by the clavicle and muscles. 

The spinal column , or the back-bone, extends from 
the base of the skull to the lower extremity of the back, 
and is composed of twenty-six bones called “ vertebrae,” 
piled one upon the other, making a strong pillar for the 
support of the head and trunk. Between each of these 
small bones is a layer of cartilage of an elastic character 
which allows the body to bend in many directions. 

The seven cervical (or neck) vertebrae extend from the 
b^se of the skull to the shoulders, the twelve dorsal 
(or back) vertebrae extend from the shoulders to the 
lower ribs. Between each articulating pair of vertebrae 
is an opening on each side for the passage of nerves 
throughout the entire length of the column—the spinal 
cord. The five lumbar (loin) vertebrae extend from be¬ 
low the ribs to the pelvis, the bones of the sacrum and 
the coccyx forming the extremity of the spine. 

The pelvis is formed by the sacrum, the coccyx, and 
the two ossa innominata. The female pelvis contains 
the womb , ovaries , Fallopian tubes , bladder , and rectum 
(see p. 308). 

Bones of the Extremities. —The humerus is the largest 
bone of the arm, and articulates with a shallow joint- 


PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 2 gg 

surface on the shoulder-blade. Under each arm is the 
axilla , containing a great bunch of nerves and blood¬ 
vessels and numerous glands. The forearm is com¬ 
posed of two bones—the radius and ulna—the radius 
being on the outer or thumb side of the forearm, where 
we feel the pulse. The elbow-joint is called a “ hinge- 
joint/’ the movements being limited to flexion to an 
acute angle and to extension in a straight line. Below 
the forearm is the wrist, and next the hand. 

The lower extremity consists of the thighs, the legs, 
and the feet. 

The femur or the thigh-bone, has a round head, and 
fits into a deep cup-shaped socket in the hip-bone. 

The patella , or knee-cap, is a small flat bone situ¬ 
ated in front of the knee-joint. The two bones of the 
leg below the knee are the tibia and fibula. The tibia 
is the stronger of the two, and is on the inner side of the 
leg. It is joined to the femur, and the fibula, which is 
long and slender, is joined to the tibia, and both articu¬ 
late with the ankle-bone (astragalus). 

3. Muscles of the Body.—The muscles are the fleshy 
portions of the body, and by their contraction and relax¬ 
ation are organs of motion. They are divided into two 
classes—those subject to the will, or voluntary muscles, 
and those not subject to the will, or involuntary muscles, 
of which the muscles of the heart and of the intestines 
are examples. The muscles differ in length and form, 
being long, short, broad, round, and flat. The smallest 
muscle in the body is the stapedius (one of the muscles 
in the ear), which is only -jt of an inch in length, and the 
longest muscle in the body is the sartorius , which is 
over 18 inches in length, reaching from the hip to below 
the knee. 


300 PRACTICAL POINTS IN NURSING. 

Running up from the sternum and clavicle to the 
mastoid process is the sterno-cleido-mastoid muscle; be¬ 
neath this is a large artery which supplies blood to the 
face and head, and the jugular vein, which, if opened, 
may cause instant death. 

The diaphragm is a sheet of muscle which separates 
the cavity of the chest from the abdomen. 

Tendons. —Tendons are white, glistening fibrous cords 
which attach certain muscles to bone. The largest 
tendon in the body is the tendo Achillis inserted in the 
heel-bone. 

Fascia. —The fascia is a fibrous membrane covering 
the muscles. It is very tough, does not stretch, neither 
can pus penetrate it. 

4. Heart, Blood-vessels, and Lymphatics. — The 
heart is a large muscular organ situated in the front part 
of the left side of the chest, pointing toward the left, and 
enclosed in a membraneous sac called the “pericardium.” 
The movements of the heart are involuntary—that is, 
are not under the control of the will—and, though the 
walls of the heart are constantly expanding to take in a 
fresh supply of blood, and contracting to drive out the 
blood, the heart has after each contraction a short rest 
of about two-fifths of a second, which, as it comes regu¬ 
larly every second, amounts at the end of twenty-four 
hours to about nine hours of total rest (see Blood-cir¬ 
culation y p. 285). 

Arteries .—The aorta, which is the largest artery in the 
body, springs from the heart. When it leaves the left 
.ventricle it forms an arch, then gives off branches which 
divide and subdivide until they become very small ves¬ 
sels, called “ capillaries.” The carotid arteries supply the 
head and the neck. The subclavian arteries are in the 


PHYSIOLOGY AND DESCRIPTIVE ANATOMY 301 

upper part of the chest. The axillary is a continuation 
of the subclavian, and passes through the armpit and 
down the inner side of the arm as the brachial artery. 
This artery divides at the elbow into the ulnar and radial 
arteries. The ulnar is on the inner side of the forearm, 
and the radial is on the outer or thumb side, and both 
supply blood to the hand and fingers. The aorta de¬ 
scends through the thorax into the abdomen, and is 
called respectively the “ thoracic ” and the “ abdominal ” 
aorta. 

The internal iliac artery supplies the walls and organs 
of the pelvis. The external iliac runs along the brim of 
the pelvis down the inner side of the thigh, where it 
takes the name of the femoral artery, whose pulsations 
can be felt in the groin. The femoral passes into the 
back of the thigh and knee, and is called the “ popliteal 
artery.” The leg and foot are supplied by the tibial and 
peroneal arteries. 

The lymphatics are the vessels which take up the 
lymph from all parts of the body, with the exception of 
the intestines, and return it into the venous system. 

5. Brain, Cord, Nerves, and Organs of the Senses. 
— The brain is composed of gray matter at the surface 
and white matter in deeper portions. It is divided into 
the big brain, or the cerebrum , and the little brain, or the 
cerebellum, and is enveloped from within outward by 
three membranes, the pia mater, the arachnoid, and the 
dura mater. The brain is supplied with about one-fifth 
of the amount of blood that the body possesses. The 
brain gives off twelve pairs of nerves which supply the 
head and face (the organs of special sense), the heart, 
the lungs, and the stomach. 

Spinal Cord .—The medulla oblongata is the enlarged 


302 PRACTICAL POINTS IN NURSING. 

upper portion of the spinal cord within the skull. It re¬ 
sembles the cord in being composed of both white and 
gray matter. It is the headquarters of the important 
nerve lines which go to the heart, lungs, stomach, and 
other prominent organs. The spinal cord is composed of 
gray and white matter, the gray matter being inside the 
cord. It is covered with membranes similar to those of 
the brain, the pia mater, the arachnoid, and the dura 
mater. It is also divided into two halves, and gives off 
thirty-one pairs of nerves, which supply the trunk, the 
extremities, and portions of the head and neck (see p. 
298). At the beginning of the spinal cord the nerve- 
fibres (see p. 254) cross from right to left, so that the 
nerves at the right side of the brain supply the left side 
of the body and vice versa. Thus, when one side of the 
brain is injured it is the opposite side of the body which 
is affected. This crossing is called the “ decussation ” of 
the nerve-fibres. 

The nervous system consists of the brain, the spinal 
cord, and the nerves. Through it all the functions of 
the body, both mental and physical, are performed. 
Thought, sensation, and motion are all under the con¬ 
trol of the brain, which is the seat of government. 

The brain, which is the chief organ of the nervous 
system, may be regarded as a central telegraph office; 
the gray matter along the spinal cord is the district 
offices, and the nerves are the telegraph wires. 

The nerves are composed of silvery-white fibres, and 
furnish both sensation and motion. The sensory (sensa¬ 
tion) fibres begin in the skin and end in the brain, and 
carry messages to the brain. The motor (motion) fibres 
begin in the brain and end in the skin, and carry mes¬ 
sages from the brain. When we want to lift up anything 


PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 303 

or to move a hand, an arm, or a foot, the brain sends a 
message over the nervous system to the muscle of what¬ 
ever part we want to move. The muscles contract and 
the part is moved. These are the nerves of motion, or 
the motor nerves. Again, when we are being burnt with 
a hot iron or injured in any way, however slight, the 
nerves of sensation reflect the message to the brain ; then 
we feel the pain, and the brain instantly sends down the 
message over the motor fibres to move the part away. 

The spinal cord gives off thirty-one pairs of nerves, 
each nerve issues from the cord by two separate roots— 
motor and sensory (motion and sensation). The cord 
has the power of reflecting messages without sending 
them to the brain ; as, for instance, if a message comes 
up a sensory fibre that a foot is being injured, the gray 
matter of the cord has the power of sending a message 
to the foot, through the motor fibres, to move the foot, 
the muscles contract, and the foot is moved. 

The vasomotor nerves are the nerves controlling the 
blood-vessels. 

Reflex action is involuntary action, such as winking or 
coughing and sneezing when the throat or nostrils are 
trying to get rid of some irritating substance. 

Eyes .—The eye, strictly speaking, consists only of the 
eyeball or eye-globe; but connected with the eyeball 
externally are muscles, nerves, blood-vessels, as well as 
other parts specially designed for its protection (see p. 
112). The cavities containing the eyeballs are called 
“orbits,” which are about 1^- inches deep. At the bot¬ 
tom are small holes through which enter the optic 
nerves. 

Nose .—The nose is composed of bone and cartilage. 

Ear .—The ear is divided into three parts—the ex- 


304 PRACTICAL POINTS IN NURSING. 

ternal ear or auricle, the middle ear, and the internal 
ear (Fig. 72). 

The miricle {pinna) is composed of cartilage covered 
with skin ( A ), and has a tube about an inch long called 
the “ auditory canal ” ( G ). The cavity of the middle ear, 
or the tympanum, is separated from the external canal by 
the drum-membrane (T). This drum-membrane is about 
one-eighth of an inch in diameter and 25-0 °f an i nc h 



Fig 72. —Semidiagrammatic section through the right ear (Czermak): G, external 
auditory meatus; T, membrana tympani; P, tympanic cavity; o , fenestra ovalis; 
r , fenestra rotunda; B, semicircular canal; S, cochlea ; Vt, scala vestibuli ; Pt, scala 
tympani. 

thickness, and has three layers—one of skin, one of 
fibrous tissue, and an inner layer of mucous membrane— 
and is also supplied with blood-vessels and nerves. The 
ear should not be picked with pins, as there is great dan¬ 
ger of perforating the drum and causing deafness. The 
middle ear (P) contains the small bones of the ear, the 
incus, stapes, and malleus, which are the smallest bones 










PHYSIOLOGY AND DESCRIPTIVE ANATOMY 305 

in the human body. The middle ear is connected with 
the back part of the throat by the Eustachian tube (if), 
the blocking of which causes deafness. The internal car 
or labyrinth consists of the vestibule (J ?), the cochlea ( 5 ), 
and three semicircular canals ( B ), also the ends of the 
auditory nerve, the nerve of hearing. Behind the ear is 
a prominence, the mastoid process, closely connected 
with the ear and the brain. Any disease of the middle 
ear may extend to the mastoid, and diseases of both the 
middle ear and the mastoid are always liable to affect the 
brain. 

6. Respiratory, Digestive, and Urinary Organs.— 

The trachea (Fig. 73, 3) extends from the larynx to the 
lungs, then divides into two branches called “ bronchi.” 
These again divide into smaller tubes called “ bronchial 
tubes,” which finally terminate in extremely fine air-cells. 

The lungs (Fig. 73, 4-6, 7, 8) are the organs of res¬ 
piration. They have a light, spongy appearance, and 
crepitate or crackle when pressed with the fingers, owing 
to the contained air in them. There are two lungs, one 
on each side of the chest. The right lung is larger 
than the left and has three lobes; the left lung, being 
smaller, owing to the room taken up by the heart, has 
only two lobes. 

The abdomen contains the stomach, liver, spleen, intes¬ 
tines, kidneys, and ureters. It is the largest cavity in the 

1 

body, and is separated from the chest above by the dia¬ 
phragm and from the pelvic cavity below by the brim of 
the pelvis. It is not, like the chest, protected on all 
sides by bone, and consequently its contained organs 
are easily injured. 

The stomach lies on the left side directly under the 

heart (see p. 290). 

20 


306 practical points in nursing. 

The liver , the largest gland of the body (weighing 
from 50 to 60 ounces), is situated on the right side of the 
body under cover of the ribs. Attached to the under 
side of the liver is a bag called the “ gall-bladder,” large 
enough to hold about 1 ounce of bile, which is a green¬ 
ish-yellow secretion of the liver. Jaundice is caused by 



Fig. 73.—Thoracic organs: 1, larynx; 2, crico-thyroid muscles; 3, trachea; 4-6, 
right lung; 7, 8, left lung; 9, pericardium; 10, mediastinum; 11 and 14, subclavian 
arteries; 12, 13, carotid arteries; 15, 16, innominate veins; 17,20, subclavian veins; 
18, 19, internal jugular veins; 21, root of lung. The lungs naturally cover the pericar¬ 
dium, but in the figure are represented as held back by hooks. 


stoppage of the gall-duct, the bile being carried into 
the blood and throughout the circulation, and giving 
the whole body a yellow appearance. 










PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 307 

The pancreas , or sweetbread, lies across the abdomen 
below the liver, nearly touching the spleen on the left. 
The secretion or juice of the pancreas is concerned in 
the digestion. 

The spleen is situated at the heart end of the stomach 
beneath the diaphragm. Its function is obscure. 

The peritoneum is the serous membrane which lines 
the abdomen and covers the various organs. 

The intestines are part of the alimentary canal (see p. 
290) continuous with the stomach; the small intestine is 
about 20 feet long, and lies in convolutions or coils in 
the abdomen, ending in the large intestine , (which is 
about 5 feet long, and runs up the right side of the body, 
crosses over under the liver and stomach and down the 
left side, ending with the rectum. The duodenum is 
the first part of the small intestine near the stomach. 
The ileum is the lower half of the small intestine; the 
ilco-cecal valve is the valve between the ileum and the 
cecum. 

The cecum is the head of the colon, and lies in the 
lower part of the right side of the abdomen. Opening 
from the cecum is the vermiform appendix (Fig. 70), a 
narrow worm-shaped tube from 2 to 5 inches long. Its 
opening is guarded by a valve, but sometimes food, seeds, 
fruit-stones, or hard fecal matter slips into the appendix, 
and inflammation may result (appendicitis). 

The colon is the first part of the large intestine, and 
passes up the right side as the ascending colon, across 
the body as the transverse colon, and down the left side 
as the descending colon, where it forms the sigmoid flex¬ 
ure (Fig. 70), which is curved like an S, and which serves 
to remove the fecal matter from the body, this action 
being done by muscles of its own. The colon ends in 


308 practical points in nursing. 

the rectum, which is from 6 to 8 inches long, and which 
terminates at the anus. 

The omentum is a fold of the peritoneum lying in 
front of the bowels like an apron. 

The kidneys are situated at the back part of the ab¬ 
dominal cavity, one on each side of the upper lumbar 
region of the spine. They are about 4 inches long, 2 
inches wide, and 1 inch thick ; the right kidney is a 
little lower than the left on account of the large space 
taken up by the liver. The kidneys excrete the urine, 
which is carried by a tube (from 12 to 16 inches long) 
called the “ ureter,” attached to each kidney, and empty¬ 
ing into the bladder. The urine passes drop by drop 
from the ureters into the bladder, which holds about a 
pint, and which is emptied by the process of urination. 
If the urine is retained in the bladder a long time, it may 
decompose, or rupture of this organ may take place 
through over-distention. 

The bladder is situated in the front portion of the pel¬ 
vis, is oval in shape, and holds about a pint. 

The urethra is a small canal that conveys the urine 
from the bladder. The opening of the urethra (the 
meatus urinarius) opens immediately above the entrance 
into the vagina. 

7. Internal Female Organs of Generation (PI. 8).— 
The womb or “ uterus,” as it is more commonly called, is 
a hollow, pear-shaped organ about 3 inches long and 2 
inches broad at the top, or fundus, and about 1 inch thick. 
It consists of the fundus, which is the rounded upper 
portion, into each side of which enters a Fallopian tube, 
of a body, and of a cervix or neck, which projects into 
the vagina, and which is about 1 inch long. The os uteri 
is the mouth of the womb. The womb is situated be- 


FEMALE GENERATIVE ORGANS 


Plate 8 . 



Blood-vessels of the pelvis (Bourgery and Jacob): the anterior part of the pelvis has been 
removed, and the bladder and the anterior vaginal wall have been partially cut away. The uterus 
is drawn up, and the Fallopian tubes are displaced into the iliac fossae (from An American Text- 
Book of Obstetrics). 









PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 309 

tween the bladder and the rectum, and any distention of 
either of these organs alters its position ; for instance, if 
the bladder is distended with urine, the womb is tipped 
backward, and if the rectum is distended with fecal mat¬ 
ter, it is tipped forward. 

The broad ligaments, which are composed of folds of 
peritoneum, connect the sides of the womb with the 
walls of the pelvis, so that the womb is suspended in the 
pelvis. 

The Fallopian tubes are from 3 to 5 inches long. They 
are attached at one end to the top of the womb, while 
the other end has a fringe-like appearance, called the 
“ fimbriated extremity,” part of which is attached to an 
ovary. 

The ovaries are two small oval bodies about IJ inches 
in length. They lie on either side of the womb about 1 
inch from its top, and are enclosed between layers of the 
broad ligament. 







APPENDIX. 


I. GENERAL RULES FOR FEEDING THE SICK, 
AND HOW TO MAKE CERTAIN ARTICLES OF 
FOOD. 

i. Serving the Food. 

The question of serving food, which is one of educa¬ 
tion and training, is of vast importance in the successful 
nursing of private patients. Much depends upon obser¬ 
vation and tact. Little things are more apt to influence 
the condition of the patient than large ones, and, no 
matter how much medical care the patient has received, 
or how successfully a difficult operation has been per¬ 
formed, or how attentive the nurse has been, the advan¬ 
tages may all be lost through some trifling mistake in 
the serving of the food. The laboring man is content 
to eat bread and meat with his fingers and to drink 
tea from his dinner-pail, but it would make a refined 
man or woman very unhappy to be compelled to eat 
from broken dishes and to be served by a nurse who 
spilled the liquids, who held a cup or a tumbler at the 
rim in offering drink, instead of holding it at the bottom 
or by the handle, who served the food cold, who tasted 
the food in the patient’s presence, who had unclean 
hands, or who wore a soiled apron. 

The serving of food requires a great deal of judgment 
and good taste, and in no branch of her work can a nurse 

311 



312 


APPENDIX. 


be of more service to a sick patient than in her ability to 
serve properly the food. The taking of food is the chief 
event of the day for a sick patient, and the patient’s 
mind should be diverted from her illness in the anticipa¬ 
tion of the meal, which should be served daintily and, if 
possible, should be composed of something unexpected. 
The tastes of the patient, however, should be consulted 
as far as possible: while it is unwise to ask the patient 
beforehand concerning the bill of fare, as it is often the 
unexpected which pleases, still, if she expresses a prefer¬ 
ence for a certain dish, it should be supplied, provided it 
is sanctioned by the physician. 

Punctuality should be observed in serving the meals, 
as frequently the appetite will be lost if the meal is de¬ 
layed beyond the accustomed hour. When a patient is 
very ill only the simplest foods are given, and these are 
prescribed by the doctor. Fluids can conveniently be 
taken by suction through a bent-glass tube or by a 
pretty feeding-cup with a spout, the cup being carried to 
the bedside on a small tray covered with a spotless nap¬ 
kin. The mouth of the patient must afterward be wiped 
dry with a fresh clean napkin (not with the corner of a 
face-towel). When convalescence sets in it becomes 
necessary to vary the food. The dishes selected should 
be savory, sufficiently varied, and suited to the digestive 
power of the patient. 

In preparing the tray the nurse should be sure first 
that it is clean on both sides, then to cover it with a 
spotless tray-cloth, and the dishes, which should be the 
prettiest and best that the house affords, should be sys¬ 
tematically arranged upon it. The tray must not be 
crowded, and discord in color should always be avoided. 
A few flowers in a small vase or laid loosely on the tray 


FEEDING THE SICK. 


313 


will add to its attractiveness. Too little rather than too 
much food should be served, and plenty of time be 
allowed for the meal, so that the food will be thoroughly 
masticated and mixed with the digestive juices. Hot 
food must be served hot , the dishes having previously 
been heated and wiped dry on the outside, and cold food 
must be served cold , lukewarm food being unpalatable. 
Pains must be taken not to spill the liquids. 

When a patient is permitted to sit up out of bed for 
an hour each day, it is generally best to utilize this hour 
for dinner, which, being the principal meal of the day, 
will then be thoroughly enjoyed, and will also be better 
digested by the patient. If the patient takes the meals 
in bed, care must be taken that a comfortable position is 
secured and that the legs are not cramped by the food- 
tray. 

Every nurse of to-day knows something of the sci¬ 
ence of bacteriology, and that foodstuffs, especially the 
animal portions, become spoiled through the presence in 
them of bacteria. Nurses have also heard lectures on, 
and understand the vast importance of, asepsis in sur¬ 
gical nursing : they would not think of doing a surgical 
dressing without first making their hands and everything 
to be used about the dressing aseptic, as the lack of such 
care might cost the patient her life. The nurse should 
be equally careful about cleansing the hands before hand¬ 
ling food, because, not knowing what germs are on her 
hands, it is possible thus to infect milk or other food 
with the bacillus of tuberculosis or of other disease. It 
is in the weakened stomach of the baby and of the inva¬ 
lid that bacteria develop and cause harmful results. That 
one has good health notwithstanding the careless prepa¬ 
ration of the food he eats, that he eats fruit which has 


3H 


APPENDIX. 


passed through an endless series of dirty hands, that he 
cools the liquids he drinks with ice gathered from ponds 
impregnated with every form of bacteria, and that a 
healthy stomach has the power to destroy many germs, 
are no arguments against absolute cleanliness and neat¬ 
ness when serving food to the sick. 

A surgical dressing must be done before meal-time, and 
all traces of the dressing cleared away. The bed must 
be arranged, the patient’s hands and face be bathed, and 
the room set in order before serving the meal. While 
eating the mind of the patient should be diverted by 
cheerful conversation, and the tray be removed as soon 
as the meal is finished. 

In most fevers patients are allowed to have a liberal 
supply of water or beverages, such as orangeade, lemon¬ 
ade, etc., which flush out the kidneys and aid in elimina¬ 
ting the worn-out material generated in the body by the 
fever. Eight grains of sodium bicarbonate, soda-water, 
or Vichy water will render sour lemonade effervescing 
and will make a very refreshing beverage. Cold drinks 
should be sipped slowly, the thirst being relieved much 
better by sipping fluids than by quickly drinking them. 
Strong black coffee should be added to milk; it is a 
heart- and brain-stimulant, and is very useful in typhoid 
fever when the patient seems to be sinking into a stupor. 

The diet-kitchen oiitfit may consist of the following 
appliances and accessories: 

A spirit- or gas-light chafing-dish; 

A single porcelain-lined saucepan ; 

A double porcelain-lined saucepan ; 

An 8-ounce measuring-glass; 

A minim measuring-glass; 

A cooking-thermometer; 


FEEDING THE SICK. 


315 


A mince-meat machine ; spoons ; a glass funnel; 

Borax ; sodii bicarbonate; 

Pancreatin powders. 

These, together with other essential articles, should be 
kept, if possible, in a small room next the patient’s bed¬ 
room, where light foods can be prepared. 

Diet in Convalescence.—The following sick-room 
dietary has been prepared as a guide for feeding conva¬ 
lescents. The diet for convalescence from typhoid fever 
may also be selected from it. 


Breakfast: 
Lunch: 
Dinner: 

Lunch: 
Supper: 


Breakfast: 

Lunch: 
Dinner: 


Lunch: 
Supper : 


Breakfast: 
Lunch: 


First Day. 

Mutton broth with bread-crumbs. 

Milk-punch. 

Raw oysters; thin bread and butter with 
crust removed; sherry wine. 

Cup of hot beef-tea. 

Milk toast; jelly; cocoa. 

Second Day. 

Oatmeal with sugar and cream; cup of 
cocoa. 

Soft custard. 

Small piece of tenderloin steak, to be 
chewed, but not swallowed; baked white 
potato. 

Glass of milk. 

Buttered milk-toast (crust removed); jelly; 
cocoa. 


Third Day. 

Soft-boiled egg; bread and butter; coffee. 
Milk-punch. 


316 

Dinner: 

Lunch: 
Supper: 

Breakfast: 


Lunch: 
Dinner: 

Lunch: 
Supper: 


Breakfast: 


Lunch: 
Dinner: 


Lunch: 
Supper: 


Breakfast: 
Lunch : 
Dinner: 


APPENDIX. 

Chicken soup; tender sweetbreads ; Bavarian 
cream; light wine. 

Egg-nog. 

Raw oysters ; bread and butter; tea. 

Fourth Day. 

Oatmeal with sugar and cream; a tender 
sweetbread; creamed potatoes; Graham 
bread and butter; coffee. 

Glass of milk. 

Chicken panada; baked potato ; bread ; tapi¬ 
oca cream. 

Cup of hot chicken broth. 

Buttered diy toast (crust removed); wine 
jelly; banquet crackers ; tea. 

Fifth Day. 

An orange; a scrambled egg; oatmeal with 
sugar and cream; soft buttered toast; 
coffee. 

Milk-punch. 

Cream-of-celery soup; a small piece of ten¬ 
derloin steak ; a baked potato ; snow pud¬ 
ding ; bread; wine. 

An egg-nog. 

Calfs-foot jelly; soft-boiled egg; bread and 
butter; cocoa. 

Sixth Day. 

Oatmeal; poached eggs on toast; coffee. 

Cup of chicken broth. 

Chicken soup; small slice of tender roast 
beef; baked potato; rice pudding; bread. 


RECIPES. 


31 7 


Lunch: 
Supper: 


Breakfast: 

Lunch: 
Dinner: 


Lunch: 
Supper: 


Breakfast: 

Lunch: 
Dinner: 

Lunch: 
Supper: 


Glass of milk. 

Baked apples; raw oysters; bread and but¬ 
ter; orange jelly; tea. 

Seventh Day. 

An orange; mush and milk; scrambled 
eggs ; cream toast; coffee. 

Cup of soft custard. 

Mutton soup; small piece of tender beef¬ 
steak ; creamed potatoes; sago pudding; 
bread; wine. 

Cup of beef-tea. 

Sponge-cake with cream ; buttered dry toast; 
wine jelly; cocoa. 

Eighth Day. 

Boiled fresh fish ; oatmeal; Graham bread; 
coffee. 

Chicken-broth. 

Potato soup ; breast of roast chicken ; mashed 
potatoes ; macaroni; blanc-mange. 

Cup of mulled wine. 

Cream toast; lemon jelly; chocolate. 


The dietary for succeeding days may be selected from 
that of preceding days. Change of diet may cause a 
temporary rise in the temperature and pulse. 

2. Recipes for Invalid Foods and Beverages. 

Simple Farinaceous Foods. —Arrowroot. — Mix 1 
teaspoonful of Bermuda arrowroot with 4 teaspoonsful 
of cold milk. Stir it slowly into half a pint of boiling 
milk, and let it simmer for five minutes. It must be 


3' 8 


APPENDIX. 


stirred all the time, to prevent lumps and to keep it from 
burning. Add half a teaspoonful of sugar and a pinch 
of salt, and if desired one of cinnamon. In place of the 
cinnamon half a teaspoonful of brandy may be used or a 
dozen large raisins may be boiled in the milk. If the 
raisins are preferred, they should be stoned and the 
sugar may be omitted. 

Corn-starch or rice-flour gruel is made in the same 
way. 

Boiled-flour Gruel.—Moisten I pint of flour with 2 
ounces of cold water; make it into a ball and tie it up 
tightly in a strong cloth. Slightly dampen the cloth, 
sprinkle it with flour, and boil it hard for ten hours ; 
then take off the cloth, and let the ball dry in a slow 
oven for ten hours more. Grate 2 teaspoonsful of flour 
from the dry ball, mix the grated flour with cold water 
to a smooth paste, and stir it into a \ pint of boiling 
milk. Simmer about three minutes, and sweeten. 

Oatmeal.—Salt to taste 3 parts of boiling water; then 
stir in slowly 1 part of oatmeal (H. O.); boil rapidly 
from twenty to thirty minutes; serve either hot or cold 
with cream or milk and sugar. 

Oatmeal Gruel No. 1.—Take 2 tablespoonsful of oat¬ 
meal, 1 saltspoonful of salt, and 1 quart of boiling water. 
Boil one hour. Strain and serve with milk or cream 
(Mrs. Lincoln). 

Oatmeal Gruel No. 2.—Pound cup of coarse oat¬ 
meal until it is mealy. Put it in a tumbler, and fill the 
tumbler with cold water. Stir well; let it settle; then 
pour off the mealy water into a saucepan. Fill again 
and pour off the water, and again repeat this, being care¬ 
ful each time not to disturb the sediment in the bottom 
of the tumbler. Boil the water twenty minutes. Season 


RECIPES. 319 

with salt. Thin with a little cream or milk. Strain and 
serve hot (Mrs. Lincoln). 

Beef-teas and Extracts. —The best pieces for beef- 
tea are the round and rump, as they contain the most 
and best-flavored juices. Wipe the meat with a wet 
cloth and remove all fat and skin. Beef-tea should not 
be allowed to boil, but should be kept at the temperature 
at which albumin coagulates, which is from 134 0 to 160°. 
Boiling water coagulates it, and beef-tea made in this 
way is without value as food. It is a stimulant. Beef- 
extract is the pure juice of the meat. Beef-tea is the 
juice diluted with water. The meat should be cut into 
small pieces, as, more surfaces being exposed to the 
water, the juices will be drawn out more quickly. Beef- 
tea should not be strained, as the sediment contains the 
nutritious part. 

Beef-essence.—Mince finely 1 pound of lean, juicy 
beef, from which all the fat has been removed; put into 
a wide-mouthed bottle or fruit-jar and cork tightly. Set 
the jar in a kettle of cold water over a slow fire, and 
let it boil for three hours. Strain and season with salt 
and red pepper. 

Bottled Beef-extract.—Cut 1 pound of lean beef 
into small pieces. Put it into a large-mouthed jar or 
bottle. Place the jar, covered, in a kettle of cold water, 
and heat slowly until near the boiling-point. Keep it at 
this temperature for two hours. Strain and press the 
meat to obtain all the juice. Season with salt. The 
water in the kettle should come nearly as high as the 
meat in the jar. In administering beef-extract, be care¬ 
ful to stir up the sediment. 

Beef-juice.—Place a \ pound of lean, juicy beef on a 
broiler over a clear hot fire and heat it through. Press 


320 


APPENDIX. 


out the juice with a lemon-squeezer into a hot cup, add 
salt, and serve hot with toast or with crackers. 

Beef-tea. —Free i pound of lean beef from fat, ten¬ 
don, cartilage, bone, and vessels; chop up fine, put into 

1 pint of cold water to digest two hours. Simmer on 
range or stove three hours, but do not boil. Make up 
for water lost in the evaporation by adding cold water, 
so that a pint of beef-tea represents i pound of beef. 
Press the beef carefully and strain and flavor to taste. 

Beef-tea may rapidly be prepared by placing the jar 
containing the meat, finely divided, without any water, 
in an oven for twenty minutes, then add boiling water 
according to the quantity required. 

Beef-tea Peptonized. —To a \ pound of raw beef, free 
from fat and finely minced, add io grains of pepsin and 

2 drops of hydrochloric acid. Put this mixture in a 
large tumbler and cover with cold water. Let it stand 
for two hours at a temperature of 90° F., being fre¬ 
quently stirred. Strain and serve in a red glass, ice- 
cold. Peptonized food does not keep well, and should 
never be used more than twelve hours old. 

Beef-tea with Oatmeal.— Mix 1 teaspoonful of well- 
cooked oatmeal with 2 tablespoonsful of boiling water. 
Add 1 cupful of strong beef-tea and bring to the boil¬ 
ing-point. Salt and pepper to taste and serve with toast 
or with crackers. Rice may be used instead of the 
oatmeal. 

Raw-meat Diet. —Scrape pulp from a good steak, 
season to taste, spread on thin slices of bread; sear 
bread slightly and serve as a sandwich. 

Meat Cure. —Procure a slice of steak from top of the 
round—fresh meat without fat; cut the meat into strips, 
removing all fat, gristle, etc. with a knife. Put the meat 


RECIPES. 


321 


through a mincer at least twice. The pulp must then 
be well beaten up in roomy saucepan with cold water or 
skimmed beef-tea to the consistency of cream. The 
right proportion is 1 teaspoonful of liquid to 8 tea- 
spoonsful of pulp; add black pepper and salt to taste; 
stir the mince briskly with a wooden spoon the whole 
time it is cooking, over slow fire or on cool part of cov¬ 
ered range, until hot through and through and the red 
color disappears. This requires about half an hour. 
When done it should be a soft, smooth, stiff puree of the 
consistency of a thick paste. Serve hot. Add for first 
few meals the softly-poached white of an egg. 

Sweetbreads.— Keep the sweetbreads in cold water 
until ready to use; then remove the fat, pipes, and mem¬ 
branes. Put them into boiling salted water, add 1 table¬ 
spoonful of lemon-juice, and cook twenty minutes. 
Drain and cover with cold water. Let them stand a 
few minutes, then drain, and they are ready to be pre¬ 
pared for the tray. 

Broths. — Chicken Broth.—Skin and chop up a small 
chicken or half a large fowl: put, bones and all, with a 
blade of mace, a sprig of parsley, 1 tablespoonful of rice, 
and a crust of bread, in a quart of water and boil for an 
hour, skimming it from time to time. Strain through a 
coarse colander. 

Clam Broth. —Wash thoroughly six large clams in 
the shell; put them into a kettle with 1 cupful of water; 
bring to boil, and keep it boiling one minute: the shells 
open, the water takes up the proper quantity of juice, and 
the broth is ready to pour off and serve hot. Add a tea¬ 
spoonful of finely pulverized cracker-crumbs, a little but¬ 
ter, and salt to taste. 

Mutton Broth. —The lean part of the neck or loin 
21 


3 22 


APPENDIX. 


should be chosen, be cut up into small pieces, and all 
superfluous fat be removed: about I pound of mutton 
thus prepared should be placed in a saucepan containing 
i pint of cold water and placed on the fire; as the scum 
rises to the top it should carefully be removed; when 
this ceases let the broth boil for about two hours, strain, 
and flavor. A teaspoonful of pearl barley, added when 
the broth begins to boil, is often acceptable. Warm up 
as wanted. 

Oysters. — Fricasseed Oysters.— To i cupful of milk 
add a J cupful of oyster liquor. When the liquids boil 
add i teaspoonful of flour and \ teaspoonful of butter, 
rubbed together; boil until it thickens; then add i 
dozen oysters: cook until the oysters are plump and 
their edges curl; serve immediately, plain or on toast. 

Peptonized Oysters.— Mince 6 large or 12 small 
oysters; add to them, in their own liquor, 5 grains of 
extract of pancreas with 15 grains of sodium bicarbonate 
(or one Fairchild peptonizing tube). This mixture is 
then brought to blood-heat (98° F.), and maintained, 
with occasional stirring, at that temperature thirty min¬ 
utes, when 1 pint of milk is added and the temperature 
kept up from ten to twenty minutes. Finally, the mass 
is brought to the boiling-point, strained, and served. 
Gelatin may be added, and the mixture served cold as 
a jelly. Cooked tomato, onion, celery, or other flavor¬ 
ing suited to individual taste may be added at beginning 
of the artificial digestion. 

Oyster Stew.— Take 1 pint of oysters, 1 pint of milk, 
1 teaspoonful of salt, \ cupful of water, 1 tablespoonful 
of butter, 1 saltspoonful of pepper. Scald the milk. 
Wash the oysters by adding the water, and remove all 
shells. Drain, saving the liquor. Put the liquor into 


RECIPES . 


323 


a stewpan and heat slowly. Skim carefully. When 
clear, add the oysters and cook slowly until the edges 
curl and they are plump. Add the hot milk, butter, 
salt, and pepper, and serve. Do not let the oysters boil, 
as that toughens them and renders them indigestible. 

Oyster Broth. —Cut into small pieces 1 pint of oys¬ 
ters ; put them into a ^ pint of cold water, and let them 
simmer gently for ten minutes over a slow fire. Skim, 
strain, and add salt and pepper. 

Puddings. — Arrowroot Pudding. —Add the yolks of 
2 eggs to the plain arrowroot recipe (see p. 317), with 
1 teaspoonful of powdered white sugar, mix well and 
bake in a lightly buttered dish for ten or fifteen minutes. 

Custard Pudding. —Break 1 egg into a teacup, and 
mix thoroughly with sugar to taste; then add milk to 
nearly fill the cup, mix again, and tie over the cup a 
small piece of linen; place the cup in a shallow sauce¬ 
pan half full of water and boil for ten minutes. 

If it is desired to make a Light Batter Pudding, a 
teaspoonful of flour should be mixed in with the milk 
before tying up the cup. 

Corn-flour Pudding. —Take 1 pint of milk, and mix 
with it 2 tablespoonsful of the flour: flavor to taste, 
then boil the whole eight minutes; allow it to cool in a 
mould, and serve up with or without jam. 

Rice Pudding. —Take 1 teacupful of rice; wash and 
pour over it boiling water, and let stand five minutes; 
then drain off the water and add a cupful of sugar to the 
rice, a little nutmeg, 2 quarts of milk, and one egg. Bake 
slowly about two hours, stirring occasionally until the 
last half hour, then brown. 

Sago Pudding. —Same as above recipe, sago being 
substituted for rice. 


324 


APPENDIX. 


Snow Pudding’. —Dissolve half a box of gelatin in I 
pint of cold water; when soft, add i pint of boiling 
water, the grated rind and juice of 2 lemons, and 2 \ 
cupsful of sugar. Let the gelatinized water stand until 
cold and begins to stiffen. Then beat in the well-beaten 
whites of 5 eggs. Pour into a mould and set on ice. 
Serve with Custard Sauce —I quart of rich milk, the 
yolks of 5 eggs, with 2 extra eggs added, and a ^ cup¬ 
ful of sugar. Flavor with vanilla. 

Soups. — Chicken Soup. —An old fowl will make a 
more nutritious soup than a young chicken. Skin, cut 
it up, and break the bones with a mallet. Cover well 
with cold water, and boil slowly for three or four hours. 
Salt to taste. A little rice may be boiled with it if 
desired. 

Mutton Soup. —Cut up fine 2 pounds of lean mutton, 
without fat or skin. Add i tablespoonful of barley, i 
quart of cold water, and a teaspoonful of salt. Let it 
boil slowly for two hours. If rice is used in place of 
barley, it will not need be put in until half an hour before 
the soup is done. 

Potato Soup. —Mash 6 boiled potatoes, I quart of 
milk, ^ pound of butter. Season with pepper and salt. 
While mashing the potatoes add the butter and gradually 
pour in the milk. Stir well and strain through a sieve, 
and heat once more. Beat up an egg and put it in the 
soup-tureen, and pour over it the soup when ready to 
serve. 

White-celery Soup. —To a \ pint of strong beef-tea 
add an equal quantity of boiled milk, slightly and evenly 
thickened with flour. Flavor with celery-seeds or pieces 
of celery, which are to be strained out before serving. 
Salt to taste. 


RECIPES. 


325 


Miscellaneous Dishes. — Macaroni.— Take of the 
macaroni \ of a pound and break into inch-lengths, and 
cook twenty minutes in 3 pints of salted boiling water. 
Turn it into a colander and pour over it cold water and 
drain. Make a sauce of 1 tablespoonful each of butter 
and flour and i-| cupsful of hot milk; salt. Put on a 
dish alternately a layer of macaroni, then a layer of the 
sauce, covering the top layer with fine bread-crumbs 
and with bits of butter dotted over (a little cheese may 
be grated over). Bake until brown. 

Creamed Potatoes. —Put 1 tablespoonful of butter 
into a frying-pan, and when it bubbles add 1 tablespoon¬ 
ful of flour; add I cupful of hot milk; salt and pepper 
to taste. Then put in 1 pint of cold boiled potatoes, 
cut into small dice; cook until thoroughly hot and 
serve. 

Omelet. —Take 4 eggs, 4 tablespoonsful of milk, \ 
teaspoonful of salt, 1 saltspoonful of pepper. Beat the 
eggs slightly with a spoon until you can take up a 
spoonful. Add the salt, pepper, and milk. Mix well. 
Put 1 tablespoonful of butter into a hot omelet-pan. 
When melted and hot pour in the egg, letting it spread 
over the pan. When the egg begins to harden, draw 
the cooked part back toward you, letting the uncooked 
egg take its place. So continue until the egg is of a 
creamy consistency. Place the pan over the hottest 
part of the fire for a few seconds to brown the omelet 
slightly. Fold over and turn out upon a hot plate (Mrs. 
Lincoln). 

Poached Eggs. —Have a frying-pan nearly full of hot 
water, not boiling but simmering. Add 1 teaspoonful 
of salt. Place in the pan as many muffin rings as there 
are eggs to be cooked. Break the eggs carefully into 


326 


APPENDIX. 


the rings. Dip the water over them with a spoon until 
a film has formed on the top of the yolk and the white 
is firm. Remove the rings and take up the eggs with a 
skimmer. Serve on buttered toast. Place a bit of but¬ 
ter and a little salt and pepper on each egg. 

Scrambled Eggs. —Take 4 eggs, J teaspoonful of 
salt, 1 saltspoonful of pepper, \ cupful of milk, 1 table¬ 
spoonful of butter. Beat the eggs slightly, add the salt, 
pepper, and milk. Put the butter into a saucepan ; when 
melted and hot add the eggs. Stir over hot water until 
of a soft, creamy consistency. Serve on buttered toast. 

Soft-boiled Eggs. —Drop 2 eggs into enough boiling 
water to cover them. Let them stand on the back of 
stove where the water will keep hot, but not boil, for 
eight minutes. An egg to be properly cooked should 
never be boiled in boiling water, as the white hardens 
unevenly before the yolk is cooked. The yolk and 
white should be of a jelly-like consistency. 

Chicken panada is made by rubbing together in a 
mortar the meat from the breast and wings of a roast or 
a boiled chicken, with an equal quantity of stale bread; 
then add gradually the water in which the chicken was 
boiled or other broth; boil for few moments and rub 
through a fine sieve. 

Infant’s Food. —About 1 teaspoonful of gelatin should 
be dissolved by boiling in \ pint of water. Toward the 
end of the boiling 1 gill of cow’s milk and 1 teaspoonful 
of arrowroot (made into a paste with cold water) are to 
be stirred into the solution, and from 1 to 2 tablespoons- 
ful of cream added just at the termination of the cook¬ 
ing. It is then to be moderately sweetened with white 
sugar, when it is ready for use. The whole preparation 
should occupy about fifteen minutes. 


RECIPES. 


32 7 


Prepared Milk. —Peptonized Milk—Cold Process. 
—Into a clean quart bottle put 1 peptonizing powder 
(extract of pancreas 5 grains, sodium bicarbonate 15 
grains) or the contents of 1 peptonizing tube (Fairchild); 

add 1 teacupful of cold water, shake; add 1 pint of 
fresh cold milk; shake the mixture again, and place 
on ice. Use when required without subjecting to heat. 
Milk so prepared will have a faintly bitter flavor; it may 
be sweetened to taste or used in punch, gruels, etc., like 
ordinary milk. 

Warm Process. —Mix the peptonizing powder with 
water and milk as described above; place bottle in water 
so hot that the whole hand can be held in it for a minute 
without discomfort; keep the bottle there ten minutes; 
then put on ice to check further digestion. Do not heat 
long enough to render the milk bitter. Peptonized milk 
may be sweetened, flavored with grated nutmeg, or 
taken with carbonated mineral water. Put the mineral 
water first into the glass, then quickly pour in the pep¬ 
tonized milk, and drink during effervescence. 

Sago Milk.— Wash 1 tablespoonful of pearl sago and 
soak it over night in 4 tablespoonsful of cold water. Put 
the sago into a double kettle with 1 quart of milk and 
boil until the sago is nearly dissolved. Sweeten to taste 
and serve either hot or cold. 

Koumyss. —Take an ordinary beer-bottle with patent 
shiftable stopper; put in it 1 pint of milk, the sixth part 
of a cake of Fleischmann’s yeast, or 1 tablespoonful of 
fresh lager-beer (brewer’s) yeast, \ tablespoonful of white 
sugar reduced to syrup; shake well and allow to stand 
in refrigerator two or three days, when it may be used. 
It will keep there indefinitely if laid on its side. Much 
waste can be saved by preparing the bottles with ordi- 


328 


APPENDIX. 


nary corks wired in position and drawing off the koumyss 
with a champagne tap. 

Toasted Bread. — Toast (dry). —Cut thin slices of 
bread into strips; toast carefully and evenly without 
breaking, slightly butter, and serve immediately on a hot 
plate. 

Cream Toast. —Take I cupful of cream, i saltspoon- 
ful of salt, 2 slices of dry toast. Scald the cream. Add 
the salt, and pour it over the toast, or make the same as 
milk toast, using cream in place of the milk. If pre¬ 
ferred, the slices of toast may be first dipped in hot salted 
water. 

Egg Toast.— Take i egg, i saltspoonful of salt, I 
cupful of milk, 6 slices of bread. Beat the egg slightly, 
add the salt and milk. Soak slices of bread in this until 
soft. Butter a hot griddle, put on the bread; when one 
side is brown, put a bit of butter on each slice, then turn 
and brown the other side. Serve with sugar and cinna¬ 
mon (Mrs. Lincoln). 

Milk Toast.— Take I cupful of milk, ^ tablespoonful 
of corn-starch, ^ tablespoonful of butter, 2 slices of dry 
toast, i saltspoonful of salt. Scald the milk. Melt the 
butter in a saucepan ; when hot and bubbling add the 
corn-starch. Pour in the hot milk slowly, beating all 
the time until smooth. Let it boil up once. Then add 
the salt. Toast two slices of bread. Pour the thickened 
milk over the slices. Let it stand five minutes. Serve. 

Peptonized Milk Toast.— Over 2 slices of toast pour 
i gill of peptonized milk (cold process); let stand on 
the back part of the range for thirty minutes. Serve 
warm or strain and serve fluid portion alone. Plain 
light sponge-cake may be similarly digested. 

Invalid’s Lunch.—A nice way to prepare a very light 


RECIPES. 


329 


lunch for an invalid (to be taken with a cup of tea) is to 
toast 3 milk crackers; then pour boiling water over 
them, drawing it off immediately; spread jam or mar¬ 
malade over the toasted crackers and pile them up on a 
dish. Set the dish of crackers in the oven while making 
the tea, and take both to the sick-room. This lunch 
will prove appetizing and refreshing if unexpected. 

Desserts. —Baked Apples. —Core and pair 2 tart 
apples; fill the core-holes with sugar; grate over the 
apples a little nutmeg; add a little water to baking-pan 
and put in oven and bake until the apples are soft. Serve 
with rich milk or cream. Sprinkle with icing sugar if 
not sweet enough. 

Bavarian Cream. —Whites of 6 eggs beaten very 
light; 1 quart whipped cream; 1 ounce of gelatin (soak 
one hour in cold water, drain, and dissolve in a little hot 
water); flavor with 1 teaspoonful of vanilla. Beat the 
eggs and cream together, add the sugar to sweeten, 
flavor, then add the gelatin. Beat again until the mix¬ 
ture begins to thicken, and pour into moulds. Serve 
very cold with cream. 

Blanc-mange of Rice. —Simmer a J pint of milk with 
1 tablespoonful of pounded white sugar until near boil¬ 
ing ; then stir in 2 ounces or 1 large tablespoonful of 
ground rice previously mixed with a ^ pint of milk until 
smooth; boil for ten minutes, stirring all the while, and 
pour into a moistened mould and serve cold. 

Soft Custard. —Take of corn-starch 2 tablespoonsful 
to 1 quart of milk; mix the corn with a small quantity 
of the milk and flavor; beat up 2 eggs. Heat the re¬ 
mainder of the milk to near boiling; then add the mixed 
corn, the eggs, 4 tablespoonsful of sugar, a little butter, 
and salt. Boil the custard two minutes, stirring briskly. 


330 


APPENDIX. 


Calf’s-foot Jelly. —Thoroughly clean 2 feet of a calf, 
cut into pieces, and stew in 2 quarts of water until re¬ 
duced to i quart; when cold take off the fat and sepa¬ 
rate the jelly from the sediment. Then put the jelly 
into a saucepan, with white wine and brandy and flavor¬ 
ing to taste, with the shells and whites of 4 eggs well 
mixed together; boil for a quarter of an hour, cover it, 
and let it stand for a short time, and strain while hot 
through a flannel bag into a mould. 

Lemon Jelly.—Take half a box of gelatin, I cupful 
of cold water, 1 pint of boiling water, 1 cupful of sugar, 
\ cupful of lemon-juice. Soak the gelatin in the cold 
water twenty minutes or until soft. Add boiling water, 
sugar, and lemon-juice; strain (Mrs. Lincoln). 

Orange Jelly.—Dissolve half a box of gelatin in a \ 
cupful of cold water. Take the juice of 6 oranges and 
of 2 lemons, 1 cupful of sugar, and 1 cupful of boiling 
water. Stir all together and strain. Put in a cold place 
and serve with “ kisses ” or a white cake. This jelly 
can be attractively served by placing it in the skins of 
the oranges cut in half and the edges notched. The 
pulp of the oranges must carefully be removed, and the 
skins thrown into cold water until required, then dried 
inside and filled with the jelly. 

Tapioca Cream.— Take I pint of milk, 2 tablespoons- 
ful of tapioca, 2 tablespoonsful of sugar, 1 saltspoonful 
of salt, 2 eggs. Wash the tapioca. Add enough water 
to cover it, and let it stand in a warm place until the 
tapioca has absorbed the water. Then add the milk and 
cook in a double boiler, stirring often until the tapioca is 
clear and transparent. Beat the yolks of the eggs. Add 
the sugar and salt and the hot milk. Cook until it 
thickens. Remove from the fire. Add the whites of 


RECIPES. 331 

the eggs, beaten stiff. When cold add 1 teaspoonful of 
vanilla. 

Peptonized-milk Jelly.— First take about half a box 
of Nelson’s gelatin, and set it aside to soak in 1 teacup¬ 
ful of cold water until needed; take 1 pint of specially 
peptonized milk, heated hot; pare 1 lemon and 1 orange, 
and throw the rinds into the specially-prepared milk; 
squeeze the juice of the lemon and orange into a glass, 
strain, and mix with it 2 or 3 tablespoonsful of wine or 
of brandy; add to the milk, stirring well; strain through 
gauze, and when cooled to a syrupy consistence, so as to 
be almost ready to set, pour into moulds and set in a 
cool place. Do not pour the milk into the moulds until 
it is nearly cool, otherwise it will separate in setting. 

Wine Jelly.— Take half a box of gelatin, ^ cupful 
of cold water, 1 pint of boiling water, 1 cupful of wine, 
1 cupful of sugar, 1 lemon. Soak the gelatin in the 
cold water until soft. Add the boiling water, wine, sugar, 
and lemon-juice. Strain. Keep on ice until ready to 
serve (Mrs. Lincoln). 

Junket. —Sweeten to taste 1 quart of fresh milk in a 
shallow dish, and stir in liquid rennet I tablespoonful; 
set near the stove, where it will get warm, and as soon 
as it begins to thicken set it on ice; serve with preserves 
and cream. This is an excellent dish for invalids; it 
may be flavored by grating nutmeg on the surface or by 
adding a few drops of brandy. 

Irish Moss. —Wash thoroughly a handful of Carrageen 
moss, pour over it 2 cups of boiling water, and let it 
stand where it will keep hot, but not boil, for two hours. 
Strain, add the juice of 1 lemon, and sugar to taste. 

Irish-moss Blanc-mange. —Take I quart of milk, \ 
cupful of Irish moss, 1 saltspoonful of salt, 1 teaspoon- 


332 


APPENDIX. 


ful of vanilla. Pick over and wash the Irish moss, and 
let it soak in cold water fifteen minutes. Drain off the 
water. Add the milk and cook in a double boiler until 
it thickens when cold. Strain. Add the salt and vanilla 
and turn into a mould. When cold serve with sugar 
and cream, also with sliced bananas (Mrs. Lincoln). 

Snow-eggs.— Take a small teacupful of new milk and 
boil it in a small, shallow saucepan with a little sugar; 
while it is boiling break i egg, putting the yolk and 
white in separate cups; whip up the white to a fine light 
froth, and when the milk is quite boiling take a large 
spoonful at a time of the white, place it on the top of 
the milk for a moment or two, then turn it, and when 
sufficiently solid lift it out on a slice; then mix up the 
yolk with some sugar, add the boiling milk, mix and 
boil again for a few minutes, then pour around the white 
and serve. 

Whipped Cream.—Mix 2 gills of rich cream, \ cup 
of pulverized sugar, and 2 tablespoonsful of sherry 
wine; put on ice for an hour, as cream whips much 
better if chilled ; whip with an egg-beater, and as the 
froth rises skim off the latter, and lay it on a sieve to 
drain, returning the cream which drips away, to be 
whipped over again. Place on the ice a short time 
before serving. 

Wine Whey.— Put 2 pints of milk into a saucepan 
and stir over a clear fire until nearly boiling; then add 
I gill (2 wineglasses) of sherry wine, and simmer a 
quarter of an hour, skimming off the curd as it rises. 
Add i tablespoonful more of sherry, and skim again for 
a few minutes ; strain through coarse muslin. Lemon- 
juice (2 tablespoonsful) may be used instead of the 
sherry wine. 


RECIPES. 


333 


Beverages. — Chocolate.— Take 2 squares of vanilla 
chocolate to each coffee-cupful of milk. Grate the 
chocolate and wet it with cold milk and stir into the 
milk when it boils. Whip a tablespoonful of cream, and 
beat it into the chocolate just as it is taken from the 
stove. This makes 1 cup of rich, delicious chocolate. 
Do not let it boil , as it becomes oily and loses its fine 
fresh flavor. 

Cocoa. —Allow 1 teaspoonful of cocoa for each cup ; 
add sufficient hot water to form a paste; pour on boiling 
milk (or milk and water) and sweeten to taste; five min¬ 
utes’ boiling will improve the cocoa (Wilbur). 

Coffee.— Stir together 2 tablespoonsful of freshly- 
ground coffee, 4 of cold water, and half an egg. Pour 
upon them 1 pint of boiling water, and let them boil for 
five minutes. Stir down the grounds, and let the coffee 
stand where it will keep hot, but not boil, for five minutes 
longer. Sugar and cream should be put into the cup 
first in serving, and the coffee poured upon them. 

Coffee (French).— Some persons prefer filtered to boiled 
coffee. Filtered coffee is best made in a French biggin, 
consisting of two tin vessels, one fitting into the other, 
the upper one being supplied with strainers. The coffee, 
very finely ground, is placed in this utensil, and the boil¬ 
ing water allowed slowly to percolate through it. The 
pot should be set where it will keep hot, but not boil, 
until the water has gone through. Pouring it through 
the coffee a second time will make it stronger, but it 
loses in flavor. Cafe noir is always made in this way. 

Crust Coffee. —Take 1 pint of crusts—those of Indian 
bread are the best—brown well in a quick oven, but 
do not let them burn; pour over them 3 pints of boiling 
water and steep for ten minutes. Serve with cream. 


334 


APPENDIX. 


Nutritious Coffee. —Dissolve a little isinglass or gela¬ 
tin (Knox) in water; put -J- an ounce of freshly-ground 
coffee into a saucepan with i pint of new milk, which 
should be nearly boiling before the coffee is added; boil 
both together for three minutes; clear it by pouring 
some of it into a cup and dashing it back again; add the 
isinglass, and leave the coffee on the back part of the 
range for a few minutes to settle. Beat up i egg in a 
breakfast-cup, and upon it pour the coffee; if preferred, 
drink without the egg. 

Rice Coffee. —Parch and grind like coffee a \ cupful 
of rice. Pour over it I quart of boiling water, and let it 
stand where it will keep hot for a quarter of an hour; 
then strain, and add boiled milk and sugar. This is nice 
for children. 

Egg-nog. —Scald some new milk by putting it, con¬ 
tained in a jug, into saucepan of boiling water, but do not 
allow the milk to boil. When cold, beat up a fresh egg 
with a fork in a tumbler with some sugar; beat to a 
froth, add a dessertspoonful of brandy, and fill up tum¬ 
bler with the scalded milk. 

Lemonade. —Squeeze the juice from i lemon. Add 
2 tablespoonsful of sugar and i cup of water. Strain 
and serve. 

Lemon Sherbet. —Take 6 lemons, I tablespoonful of 
gelatin, I quart of cold water, I pint of sugar. Soak 
the gelatin in ^ cupful of cold water twenty minutes. 
Then add \ cupful of boiling water, the juice of the 
lemons, the cold water, and the sugar. Strain and 
freeze. 

The water used in soaking and dissolving the gelatin 
should be part of the quart of water. In freezing, use 
one part salt to three parts finely broken ice. Rock salt 


RECIPES. 


33 5 


is most generally used. If you have no freezer, a very 
good sherbet may be made by freezing it in a tin pail 
packed in a pailful of salt and ice. Let it stand fifteen 
minutes. Remove the cover, scrape the frozen mixture 
from the side of the pail, mix thoroughly, cover, and let 
it stand fifteen minutes more; then scrape down again. 
Repeat this process until the mixture is frozen sufficiently 
(Mrs. Lincoln). 

Egg Lemonade. —Beat i egg with i tablespoonful of 
sugar until very light; stir in 3 tablespoonsful of cold 
water and the juice of a small lemon; fill glass with 
pounded ice and drink through a straw or a glass tube. 

Sterilized Milk. —Put the required amount of milk in 
clean bottles (if for infants, each bottle holding enough 
for one feeding). Plug the mouths of the bottles lightly 
with rubber stoppers; immerse to their shoulders in a 
kettle of cold water; boil twenty minutes; or, better, 
steam thirty minutes in ordinary steamer; firmly push 
the stoppers in the bottles, cool them rapidly, and keep 
in refrigerator. Warm each bottle just before using. 

Milk and Albumen. —Put into a clean quart bottle 1 
pint of milk, the whites of 2 eggs, and a small pinch of 
salt. Cork and shake hard for five minutes. 

Milk-punch. —Take ^ pint of fresh cold milk and add 
2 teaspoonsful of sugar, and stir well until dissolved; 
then add 1 ounce of either brandy or sherry wine. 

Mulled Wine. —Take a ^ cup of boiling water into 
which put 2 teaspoonsful of broken stick-cinnamon and 
6 whole cloves, and let all steep for ten minutes, then 
strain. Now take 2 eggs and 2 tablespoonsful of sugar; 
beat them together until very light, and stir into the 
spiced water. Pour from height into this mixture a cup¬ 
ful of sweet wine boiling hot (the wine should not be 


336 


APPENDIX. 


boiled in a tin vessel). By pouring this preparation from 
one pitcher to another several times it will become light 
and foamy. Serve hot. 

Orangeade.—Substitute orange-juice for that of lemon 
in the recipe for Lemonade. 

Orange Sherbet.—Take i^- cupsful of orange-juice, I 
tablespoonful of gelatin, ^ cupful of cold water, \ cup¬ 
ful of boiling water, i cupful of sugar, i pint of cold 
water. Soak the gelatin in the cold water. Then add 
the boiling water, the orange-juice, the sugar, and the 
cold water. Strain and freeze. Any kind of fruit-juice, 
sweetened and diluted, may be used in place of the 
orange-juice. 

Tea.—Scald out the teapot and put in the tea, using i 
teaspoonful for each cupful. Pour on boiling water, and 
let teapot stand four or five minutes. If allowed to 
stand too long, the tannin in the tea is developed, which 
not only darkens the tea, but also renders it hurtful. 

Flaxseed Tea.—Flaxseed (whole), i ounce; white 
sugar, i ounce (heaping tablespoonful); licorice-root, J 
ounce (two small sticks); lemon-juice, 4 tablespoonsful. 
Pour on these materials 2 pints of boiling water; let it 
stand in a hot place four hours; strain off the liquor. 

Albumen-water.—Stir the whites of 2 eggs into a \ 
pint of ice-water, without beating; add enough salt or 
sugar to make it palatable. 

Apple-water.—Slice into a pitcher -t a dozen juicy 
sour apples; add 1 tablespoonful of sugar, and pour 
over them 1 quart of boiling water. Cover closely until 
cold, then strain. 

Barley-water.—Wash 2 ounces (wineglassful) pearl 
barley with cold water. Boil it five minutes in fresh 
water; throw both waters away. Pour on 2 quarts 


MINERAL WATERS. 


33 7 


boiling water; boil down to I quart. Flavor with thinly- 
cut lemon-rind ; add sugar to taste. Do not strain unless 
at the patient’s request. 

Gum-arabic Water.—Dissolve I ounce of gum- 
arabic in i pint of boiling water, add 2 tablespoonsful 
of sugar, a wineglassful of sherry, and the juice of i 
large lemon. Cool, and add ice. 

Lime-water.—Pour 2 quarts of hot water over fresh 
unslaked lime of the size of a walnut; stir until slaked, 
and let stand until clear, then bottle. Lime-water is 
often ordered with milk to neutralize acidity of the 
stomach. 

Rice-water.—Pick over and wash 2 tablespoonsful of 
rice; put into a granite saucepan with i quart of boiling 
water; simmer two hours, when rice should be softened 
and partially dissolved; strain, add saltspoonful of salt; 
serve warm or cold. May add sherry or port wine, 2 
tablespoonsful. 

Tamarind-water.—A very refreshing drink may be 
made by adding i pint of hot water to I tablespoonful 
of preserved tamarinds, and setting aside to cool. 

Toast-water.—Toast 3 slices stale bread to a dark 
brown, but do not burn. Put them into a pitcher; pour 
over them 1 quart of boiling water; cover closely and 
let stand on ice until cold; strain. May add wine and 
sugar. 

MINERAL WATERS. 

Alkaline waters contain sodium carbonate and bicar¬ 
bonate in comparatively large amounts. The conditions 
in which these waters produce their best effects are— 
Chronic gastric catarrh, especially with hyperacidity 
and catarrhal inflammation of the mucous membrane of 


22 


APPENDIX. 


338 

the biliary passages. Good results have been obtained 
in acute catarrhal nephritis; also in lithemia, gout, and 
chronic rheumatism. 

Carbonic-acid waters owe their potency to the pres¬ 
ence of carbonic-acid gas. Any variety of water may be 
found impregnated with this gas, whose presence possi¬ 
bly increases the diuretic effects of the water. Fever- 
patients find these waters very agreeable. The addition 
of this gas acts as a sedative to the gastro-mucous mem¬ 
brane, and when taken cold and in sips relieves nausea 
and tends to check vomiting. Carbonic-acid water 
added to milk is admirably received by some patients 
with irritable stomach, and occasionally milk will be 
accepted in this form when it is absolutely refused in the 
pure state. Another very popular use to which these 
waters are put is in diluting wines. 

Chalybeate waters are those holding in solution one 
or more of the iron compounds, most frequently ferrous 
bicarbonate and ferrous oxid. Iron waters owe their 
virtues to the presence of iron, which usually exists in 
the form of the bicarbonate of the protoxid, held in 
solution by an excess of carbonic-acid gas. The ordi¬ 
nary indications for the use of iron are met by employ¬ 
ing waters of this class. They are useful in anemia, but 
usually have other constituents, whose administration 
may or may not be indicated in certain cases. 

Purgative waters usually owe their properties to 
sodium sulphate and magnesium sulphate. When a 
gentle saline laxative is indicated, these waters often give 
better results than either Epsom or Glauber’s salt, and 
are therefore of greater service. In congestion of the 
liver, chronic gastric catarrh with atony, jaundice, lithe¬ 
mia, gout, and in the obese, the regular use of water of 


MINERAL WATERS. 339 

this class properly selected and administered yields excel¬ 
lent results. 

Saline waters contain common salt in solution, also 
small quantities of the chlorids, of the alkalies, and of 
alkaline earths. This saline when taken into the stomach 
dissolves albumin and starches; promotes digestion and 
absorption of food; supplies the intestines with chyme 
rich in albumin and starches; enters the blood, which 
carries the salt to all the tissues of the body after sup¬ 
plying its own needs. The usefulness of these waters, 
however, is very restricted. Good results may be ex¬ 
pected in certain dyspepsias with defective gastric secre¬ 
tion and sluggishness of the bowels. In certain cases 
of dyspepsia these results are best obtained by adminis¬ 
tering the water early in the morning, before breakfast; 
when rapid absorption is necessary it should be taken 
hot. Preference should be given to those springs charged 
with carbonic-acid gas, which greatly increases the pala¬ 
tableness of this class of waters. The therapeutic dose 
is from I to 5 fe daily. 

Sulphuretted waters are due to the presence in the 
water of sulphuretted hydrogen gas, and they usually 
contain the sulphates of sodium and potassium. When 
taken internally, they augment peristalsis and perspira¬ 
tion. Frequently sulphur springs are used as baths, and 
with good results, especially in chronic skin-affections— 
such as eczema—in rheumatism, and in gout. The 
waters are useful in constipation, and are asserted to 
have produced good results in cases of chronic bronchitis 
and phthisis. In all these diseases they are administered 
internally and used externally as baths. 


340 


APPENDIX. 


II. WEIGHTS AND MEASURES. 


apothecaries’ weight. 


Pound—lb. Ounces— 3 . 

Drachms— 3 . Scruples— 3 . 

Grains—gr. 

Metric 

grammes. 

I = 12 = 

96 = 288 = 

5760 = 

372.96 

I = 

II 

N 

II 

00 

480 = 

31.08 


I 3 

60 = 

3.885 


I = 

20 = 

1-295 


apothecaries’ (wine) measure. 


Gallon—C. Pints—O. 

Fluidounces—fS. 

Fluidrachms—f 5 . 

Minims—ll\. 

1=8 = 

128 = 

IO24 = 

61,440 

I = 

l6 = 

128 = 

7680 


I = 

8 

480 



I = 

60 


COMPARATIVE VALUES OF 

apothecaries’ and metric 




FLUID MEASURES. 



Minims. 

Cubic 

centimetres. 

Minims. 

Cubic 

centimetres. 

Minims. 

Cubic 

centimetres. 

I 

= 

O.061 

II = 

O.678 

40 = 

2.36 

2 

= 

O.I23 

12 = 

0-739 

50 - 

3.08 

3 

= 

O.185 

13 = 

O.801 

Fluidrachms. 

4 

= 

0.246 

14 = 

0.862 

I = 

3.7 

5 

= 

0.308 

15 = 

O.924 

2 = 

7-39 

6 

= 

O.370 

l6 = 

I. OO 

3 = 

11.09 

7 

= 

O.43I 

17 = 

I.06 

4 = 

15.00 

8 

= 

0-493 

18 = 

1.12 

5 - 

18.50 

9 

= 

0-544 

20 = 

I.23 

6 = 

22.50 

10 

= 

O.616 

30 = 

1.84 

7 = 

26.00 

Fluid- 

ounces. 

Cubic 

centimetres. 

Fluid- 

ounces. 

Cubic 

centimetres. 

Fluid- 

ounces. 

Cubic 

centimetres. 

1 

= 

30 . 00 1 

8 = 

236.59 

20 = 

59 I -50 

2 

= 

59-14 

9 = 

266.16 

22 = 

650.62 

3 

= 

89.00 

IO = 

295-73 

24 = 

710.00 

4 

= 

118.29 

12 = 

355-00 

28 = 

828.26 

5 

= 

148.00 

14 = 

414.00 

32 = 

946.35 

6 

= 

177.42 

10 = 

473.17 

0 -*» 8 1 4 

1000.00 

7 

= 

207.00 

18 = 

532-32 

128 ' = 

3785.43 


1 More accurately, 29.57 c.c. 


WEIGHTS AND MEASURES. 


341 


APPROXIMATE MEASURES. 


One minim varies from one to two drops. 1 
1 fluidrachm = (about) I teaspoonful. 


2 fluidrachms = 
^ fluidounce = 
2 fluidounces = 
4 fluidounces = 


1 dessertspoonful. 
1 tablespoonful. 

1 wineglassful. 

1 teacupful. 


HOUSEHOLD MEASURES. 


4 teaspoonsful of liquid = 

1 pint of liquid = 

2 gills of liquid = 

2 rounded tablespoonsful of flour = 

1 tablespoonful of butter = 

2 cups of granulated sugar = 

2^ cups of powdered sugar = 


1 tablespoonful. 
1 pound. 

1 cup. 

1 ounce. 

1 ounce. 

1 pound. 

1 pound. 


ANTISEPTIC SOLUTIONS 2 (e. Q. THORNTON, M. D.). 


Drug. 

Com¬ 

mercial 

Solution. 

Strength. 

Per 

form. 


cent. 

Boric Acid. 

Powder. 

Two tablespoonsful to a pint. 

1 : 33 

3 

Calcium Chlorid . . . 

Masses. 

Two teaspoonsful to a pint. 

1 ; 50 

2 

Carbolic Acid .... 
Corrosive Chlorid of) 

Liquid. 

Six teaspoonsful to a pint. 

1 : 20 

S 

Mercury (corrosive > 
sublimate) . ... j 

Crystals. 

Seven and a half grains to a pint. 

1 : 1000 

O.I 

Creolin. 

Liquid. 

Two and a half teaspoonsful to a pint. 

1 : 50 

2 

Lysol. 

Liquid. 

Two and a half teaspoonsful to a pint. 

1 : 50 

2 

Potassium Perman-f 
ganate.j 

Crystals. 

Half a teaspoonful to a pint. 

1 : 250 

0.4 

Solution of Hydrogen ) 
Dioxid.j 

Liquid. 

Eight tablespoonsful to a pint. 

1 : 4 

25 

Thymol. 

Crystals. 

Five grains to a pint. 

1 : 1500 

.07 

Zinc Chlorid. 

Crystals. 

Two teaspoonsful to a pint. 

1 : 50 

2 


1 A drop is popularly, although erroneously, supposed to be a minim. True, there 
are 60 drops in a fluidrachm of water, but this is the case with only a few liquid med¬ 
icines. The size of a drop depends on the shape of the vessel from which it is being 
dropped and on the adhesiveness of the fluid dropped ; consequently, a drop is a very 
indefinite quantity. Tinctures, spirits, and other alcoholic fluids drop from 120 to /jo 
drops to the fluidrachm, whereas thick syrups and a few other liquids drop less than bo 
drops to the fluidrachm (Thornton). 

2 These antiseptic solutions are of ordinary strengths, and are intended only for local 
application. They may be prepared with either hot or cold (preferably distilled) water. 
To decrease the strength of either solution the quantity of water must be increased; 
for example, if a 1 : 2000 corrosive-sublimate solution is required, the proportion would 
be 7^ gr. to the quart. 






















342 


APPENDIX. 


TABLE SHOWING THE NUMBER OF DROPS IN A FLUIDRACHM OF VARIOUS 
LIQUIDS; ALSO THE WEIGHT OF ONE FLUIDRACHM IN GRAINS. 


Liquid. 

Drops 
in f 3 j 
(ITllx). 

Weight 
of f 5 j in 
grains. 

Liquid. 

Drops 
in f 5 j 

(mix). 

Weight 
of f 3 j in 
grains. 

Acetum Opii. 

90 

61 

Liquor Iodi Compos . . 

63 

59 

“ Scillae. 

68 

57 

a 

Potassae .... 

62 

58 

Acid, Acetic. 

108 

58 

a • 

Zinci Chloridi . 

89 

88 

“ Acetic, Dil. . . . 

68 

55 

Oleoresin Aspidii . . . 

130 

52 

“ Carbolic .... 

hi 

59 

if 

Capsici . . . 

120 

5 i 

“ Hydrochloric . . 

70 

65 

a 

Cubebae . . . 

123 

52 

“ Hydrocyanic . . 

60 

54 

Oleum Anisi. 

H 9 

54 

“ Lactic. 

III 

66 

it 

Bergamii . . . 

130 

46 

“ Nitric. 

102 

77 

a 

Cari. 

132 

50 

“ Nitro-hydrochlor. 

76 

66 

a 

Juniperi .... 

148 

49 

“ Phosphor. Dil. . 

59 

57 

a 

Limoms .... 

129 

47 

“ Sulphuric .... 

128 

101 

a 

Ricini. 

77 

5*^4 

“ Sulph. Aromat. . 

146 

53 

a 

Rosae. 

132 

47 

“ Sulph. Dil. . . . 

60 

ssy 2 

a 

Terebinth. . . . 

136 

45/4 

“ Sulphurosum . . 

59 

55 

a 

Tiglii. 

104 

50 

A£ther Fortior. 

176 

39 

Spiritus Auheris Comp. 

148 

45 

Alcohol. 

146 

44 

it 

ALtheris Nitrosi 

146 

47 

Aqua. 

60 

55 

a 

Camphorae . . 

I 43 

47 

“ Destillata .... 

60 

53/4 

Syrupus Acaciae .... 

44 

73 

Bals. Peruvian .... 

IOI 

60 

a 

Ferri Iod. . . 

65 

77 

Bromin. 

250 

165 

a 

Scillae .... 

75 

74 

Chloroform, Pur. . . . 

250 

80 

a 

Comp. . . . 

102 

70 

Copaiba. 

no 

5 1 

a 

Senegae . . . 

106 

70 

Creasote . 

122 

56}4 

a 

Simplex . . . 

65 

72 

Extractum Belladon. FI. 

156 

57 

Tinctura Aconiti . . . 

I46 

46 

“ Buchu FI. . 

150 

47/4 

if 

Belladonnae 

*37 

53 

Digitalis FI. 

134 

62 

it 

Benzoini Comp. 

148 

48 

Ergotae FI. . 

133 

60 

< i 

Cantharidis. . 

131 

5 i 

Ipecac. FI. . 

120 

60 

if 

Digitalis . . . 

128 

53 

" Rhei FI. . . 

158 

61 

it 

Ferri Chlor. . 

150 

53 

Senegae FI. . 

137 

62 

it 

Iodi. 

148 

47 

“ Valerianae FI. 

150 

49 

ii 

Opii. 

130 

53 

" Zingib. FI. 

142 

48 

it 

Opii Camph. . 

130 

52 

Glycerin. 

67 

68 

ii 

Opii Deodor. . 

no 

54 

Hydrargvrum. 

150 

760 

Vinum Colchici Rad. . 

107 

53 

Liquor Acidi Arsenosi . 

57 

55 

ii 

Colchici Sem. . 

in 

54 

“ Ferri Chloridi . 

71 

72 

it 

Opii. 

100 

55 


LIST OF HYPODERMATIC TABLETS. 


Aconitin (crystals) . 

• g r • T 5 D- 

Morphin sulphate .... 



Apomorphin muriate. 

• gr- rV 

Morphin and atropin. No. 

I. 

Atropin sulphate. 

• gr. 00 • 

Morphin Sulph. . . . 


• • gr- b 

Atropin sulphate. 

■ gr. t fa- 

Atropin Sulph. . . . 


• • gr. 550 - 

Cocain hydrochlorate. 

• gr. b 

Morphin and atropin, No. 

2. 

Conin hydrobromate. 

• gr- b 

Morphin Sulph. . . . 


• • gr. b 

Colchicin. 


Atropin Sulph. . . . 


• • gr. TxtJ* 

Corrosive sub. and urea .... 

• gr- 5 V 

Picrotoxin. 



Digitalin (soluble). 

• gr. lntr- 

Pilocarpin hydrochlor. 


• • gr. b 

Gelsemin muriate. 

• gr- so- 

Pilocarpin nitrate .... 


• • gr. b 

Hyoscin hydrobromate .... 

• gr- t bo- 

Physostigmin sulph. . . . 


• • gr- jbO' 

Hyoscyamin. 

• gr. bo • 

Sodium arsenate. 


■ ■ gr. tV 

Morphin sulphate. 

• gr. b 

Strychnin sulphate .... 
Strychnin sulphate.... 


• • gr. bV 

• • gr. T ho. 


Tablets for hypodermatic use are prepared by prominent manufacturers, each tablet 
containing one dose. They may readily be dissolved in a teaspoon at the bedside, and 
are very convenient for the pocket, if put up in a case with a good hypodermic syringe. 





























































TABLE FOR CALCULATING THE DATE OF CONFINEMENT. 


CONFINEMENT TABLE, 


343 


Nov. 

Dec. 

G 

d 

C—l 

Feb. 

Mar. 

April, 

• 

>N 

a 

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344 


APPENDIX. 


IV. ABBREVIATIONS. 


aa., ana, equal parts of each. 

A. c., ante cibum, before meals. 

Add., adde, add to it. 

Ad. lib., ad libitum, as you please. 

Alt. dieb., alterna diebus, every other 
day. 

Alt. hor., alterna horis, every other 
hour. 

Alt. noc., alterna node, every other 
night. 

Ante cib., ante cibum , before meals. 

Applic., applicatur, apply. 

Aq., aqua, water. 

Aq. font., aqua fontana, spring water. 

Aq. bull., aqua bulliens, boiling 
water. 

Aq. dest., aqua destillata, distilled 
water. 

Aq. marin., aqua marina, sea-water. 

Aq. pluvial., aqua pluvialis, rain¬ 
water. 

Aq. pur., aqua pura, pure water. 

Bis hor, or bis horis, every two 
hours. 

Bis ind., bis in dies, twice a day. 

Bull., bulliat, let it boil. 

C. or Cong., congius, a gallon. 

c. c., cubic centimetre. 

Cap., capiat, let him take. 

Cent., centigrade. 

Cochleat., cochleatim, by spoonfuls. 

Cochl., cochleare, spoonful. 

Coch. mag., cochlear magnus, a 

tablespoon. 

Coch. med., cochlear medium, a 

dessertspoon. 

Coch. parv., cochlear parvum, a 

teaspoon. 

Comp., compositus, compound. 


Conf., confedio, a confection. 

Cort., cortex, bark. 

Cuj., cujus, of which. 

Decoct, hord., decodum hordei, bar¬ 
ley-water. 

Decub., decubitus (a bed), lying 
down. 

Destil., destilla, distil. 

Det., detur, let it be given. 

Dil., dilutus, dilute. 

Dim., dimidius, one-half. 

Div., divide. 

Div. in p. seq., dividatur in partes 
cequales, divide into equal parts. 
Drachm., drachma, a drachm. 

Duo., duo, two. 

Emp., emplastrum, a plaster. 

Enem., enema. 

Extr., extradum, extract. 

F., Fahrenheit. 

F. mist .,Jiatmistura, make a mixture. 
Far., faradic. 

F e.,ferrum, iron. 

Filt., filtra, filter. 

F. pi 1 ., fiat pilula, make a pill. 

Fot., fotus, a fomentation. 

Freq., frequenter, frequently. 

FI., or f .,fluidus, fluid. 

Ft.,fiat, let there be made. 

F%, fluidrachma, fluidrachm. 

F^, fluiduncia, fluidounce. 

Garg., gargarisma, a gargle. 

Gm., gramme. 

Gossyp., gossypium, cotton-wool. 

Gr., granum, a grain, or gratia, 
grains. 

Gtt., gutta, a drop, or guttce, drops. 
Guttat., guttatim, by drops. 

Hg., hydrargyrum, mercury. 


ABB RE VIA TIONS. 


Hirud., hirudines, leeches. 

Hor. decub., hora decubitus, at bed¬ 
time. 

Ind., in dies, daily. 

Inf., infusum , an infusion. 

Inject., injectio, an injection. 

Lat. dol., lateri dolenti , to the 
affected side. 

L. , litre. 

Lb., libra, a pound. 

Lib. or lbs., librce, pounds. 

Lim., limones, lemons. 

Liq., liquor. 

Lot., lotio, a lotion. 

M. , misce, mix. 
ttb, minimum. 

Mac., macera, macerate. 

Man., manipulus , a handful. 

Mass, pil., massa pilularum, pill- 
mass. 

Mel., mellita, honey. 

Mist., mislura, a mixture. 

No., numero , in number. 

Noct., node , at night. 

O., odarhis , a pint. 

01., oleum, oil. 

Ol. oliv., oleum olives, olive oil. 

O. m., omni mane, every morning. 
Ov., ovum, an egg. 

Oz., uncia, ounce. 

P. or Pug., pugilhis, a pinch 

P. c., post cibum, after meals. 

Pil., pilula, a pill. 

Pond., pondere, by weight. 

Pt., pint. 

P. R. N., pro re nata, as occasion 
arises. 

Pulv., pulvis, a powder. 

Q. d., quarter in die, four times a 
day. 


345 

Q. P., quantum placet, as much as 
you please. 

Q. S., quantum sufficit, as much as 
is sufficient. 

Qt., quart. 

Quotid., quotidie, every day. 

Q. V., quantum vis, as much as you 
wish. 

recipe, take. 

Rad., radix, root. 

Rect., rectificatus, rectified. 

S. or Sig., signa, write. 

Scr., scrupulum , scruple. 

Sem., semen, seed. 

Sob, solution. 

Spr., spiritus, spirit. 

Sp. gr., specific gravity. 

St., stet, let it stand. 

SS. or s., semissis, a half. 

Sum., sumendus, to be taken. 

S. V. G., spiritus vini gallici, 
brandy. 

S. V. R., spiritus vini rectificatus, 
alcohol. 

S. F., spiritus frumenti, whiskey. 
Syr., syrupus, syrup. 

T. , temperature. 

T., ter, three times. 

T. i. d., ter in dies, three times a day. 
Tr., tinctura, tincture. 

Troch., trochisci, lozenges. 

Ung., unguentum, ointment. 

W., weight. 

3, drachma, a drachm. 

, uncia, an ounce. 
scrupulum, a scruple. 

2 dis., every two hours. 

3 tis., every three hours. 

4 tis., every four hours. 

6 tis., every six hours. 


/ 



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348 


APPENDIX. 


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(S) 

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Drops. 


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English name. Latin official name. Synonym or popular 


350 


APPENDIX : 


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DOSE-LIST. 


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354 


APPENDIX. 


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356 


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353 


APPENDIX. 



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DOSE-LIST 


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GLOSSARY 


A. 

Abdomen. The belly ; the cavity 
between the chest and the groins. In 
abdominal injuries a nurse has usu¬ 
ally to keep her patient at rest and 
watch for signs of peritonitis. Lapar¬ 
otomy is the operation likely to be 
performed. 

Abdominal. Pertaining to the ab¬ 
domen. 

Abductor. A muscle which draws 
a limb from the median line of the 
body. 

Abnormal. Irregular,a deviation 
from the usual course. 

Abortion. Miscarriage before the 
fourth month. 

Abscess. A collection of pus in a 
cavity, the result of inflammation. 
If it disappears without being opened 
it is said to be dispersed. An abscess 
wound should pucker, and the edges 
sink; the pus should be whitish- 
green, inodorous, and moderately 
liquid. 

Absorbents. Wool and other 
dressings which suck up moisture. 

Absorption. The sucking up of 
substances by the lymphatic vessels. 

Accident. A casualty or unfore¬ 
seen event not characteristic of dis¬ 
ease. An unexpected symptom. 

Accoucheur. An obstetrician, a 
midwife. 

A. C. E. Mixture. An anesthetic ; 
i part alcohol, 2 parts chloroform, 
and 3 parts ether. 

Aceta. Solutions of medicines in 
vinegar^ 

Acetabulum. The cup-like socket 
into which the head of the femur 
fits. 

Acetic Acid. Vinegar. 

Achilles Tendon. The large ten¬ 
don attached to the heel-bone. 

Acid. A compound which is 
capable of uniting with alkalies, but 
which when liquid has a sour taste, 

* 24 


and turns blue litmus paper red. 
Vinegar and lemon-juice are acids. 

Acidity. The quality of being 
sour ; sharpness to the taste. 

Aconite. A poisonous anodyne, 
sometimes used as a cardiac sedative. 
It increases perspiration. 

Acrid. Sharp, burning. 

Action. The mode in which one 
object influences another. Actions 
may be divided into several classes, 
as chemical, organic, and physical. 
Vital actions are those necessary to 
life; physiological actions are those 
which are normal; pathological ac¬ 
tions are those presented in a diseased 
condition. 

Acupressure. Arrest of bleeding 
by means of long pins, with glass 
heads, passed across the course of 
the artery. 

Acupuncture. Insertion of nee¬ 
dles to treat certain diseases. 

Acute. A severe but short attack 
of disease. 

Adductor. A muscle which draws 
toward the median line of the body. 

Adhesion. The process by which 
severed tissues unite. 

Adipose. Fatty. 

Adjuvant. A secondary ingredi¬ 
ent in a prescription, aiding the chief 
drug. 

Adolescence. The period be¬ 
tween puberty and maturity. From 
14 to 25 in a man, 12 to 21 in a 
woman. 

Adult. A person who has passed 
the age of maturity. 

Adynamic. Defect of power, 
weakness. 

Affection. Any condition in which 
mind or body is modified or affected ; 
disease, febrile affection, cardiac af¬ 
fection, etc. 

Afferent. Conveying from surface 
to centre; applied to the lymphatic 





3 /o 


APPENDIX. 


Affusion. Pouring water upon the 
body as a remedy. 

After-birth. A vascular organ 
which nourishes the fetus and is ex¬ 
pelled after labor; placenta. 

After-care. The care or nursing 
of convalescents.. 

After-pains. Pains from uterine 
contraction following labor. 

After-treatment. (See After-care.) 

Agalactia. Lack of milk in a 
mother. 

Ague. An intermittent fever at¬ 
tended by alternate hot and shiver¬ 
ing fits. If the fits occur every 24 
hours it is called “ quotidian ague ” ; 
if every 48 hours, “ tertian ague ; if 
72 hours, a “ quartan ” ; if 96 hours, 
a “ quintan.” A nurse attending a 
case should have her thermometer, 
hypodermic syringe, and enema. 
Taking the temperature during hot 
and cold fits is very important. If 
quinin is not given as a medicine, it 
is often given as a subcutaneous in¬ 
jection, or by enema. 

Air-bed. A mattress made of 
india-rubber and filled with air. 
Water-beds are filled with water. 

Air-cell. An air-sac ; an air-vesi¬ 
cle of the pneumonic tissue. 

Air-cushions. Cushions of vari¬ 
ous shapes made of india-rubber and 
filled with air, which the nurse blows 
in through a valve. 

Air-passages. The respiratory 
organs—larynx, bronchia, etc. 

Air-pump. An apparatus by 
which the air may be exhausted from 
a communicating vessel. 

Alalia. Defect of speech caused 
by paralysis. 

Albino. A person with white hair, 
fair skin, and pink eyes; caused by 
pigmentary deficiency. 

Albumin. A proteid substance, 
the chief constituent of the body. 

Albuminuria. The presence of 
albumin, asubstance resembling white 
of egg, in the urine; a condition cha¬ 
racteristic of kidney-disease. A syn¬ 
onym of Bright's disease. Test for 
albumin: the application of heat 
gives an opacity that does not clear 
on the addition of nitric acid. 

Alcoholism. A morbid state pro¬ 
duced by excessive drinking of wines 


or spirits. Watch for delirium tre¬ 
mens and morning vomiting. 

Alimentary Canal. The tube 
through which the food passes from 
the mouth to the anus. 

Alkali. The opposite to an acid ; 
a soapy substance. Turns red litmus 
paper to blue. Soda and potash are 
alkalies. 

Aloes. The juice of several varie¬ 
ties of aloe ; astringent and cathartic. 

Alopecia. Absence of hair, bald¬ 
ness. 

Alterative. A remedy which 
works by an unknown process. 

Alum. Crystals of aluminum and 
potassium. Very astringent, slightly 
emetic. Salts, of aluminum are used 
as a non-volatile antiseptic. Alum 
dusted on wounds acts as a styptic, 
and arrests bleeding. 

Alveoli. The sockets of the teeth. 

Ambidexter. Equally skilful with 
both hands. 

Amblyopia Indistinct vision ; ap¬ 
proaching blindness. 

Amenorrhea. Abnormal absence 
of the menses. 

Amentia. Defect of intellect, idi¬ 
ocy. 

Ammonia. A volatile alkali with 
a pungent odor. Stimulant, also 
used as an expectorant. Chlorid of 
ammonium is often given as an in¬ 
halation, when it generally falls to 
the nurse to charge the inhaler. 

Amnesia. Loss of memory. 

Amnion. The sac directly encir¬ 
cling the fetus in utero. 

Amniotic Fluid. (See Liquor 
amnii .) 

Amputation. The removal of a 
limb or an organ. It is termed pri¬ 
mary if performed immediately after 
the injury; secondary if performed 
later, because inflammation has set in. 
A nurse should note the number of lig¬ 
atures and sutures used. The strap¬ 
ping to keep the flaps together should 
be fi inch broad for forearm to 1 'A 
inch for thigh. The stump should be 
kept raised, and with no clothes 
weighing on it. Watch constantly 
for bleeding or collapse. 

Amyl. A radical composed of 
carbon and hydrogen. Amyl nitrite 
is sometimes inhaled (5 drops on 



GL OSSARY. 


lint) in angina pectoris, epilepsy, etc.; 
it should be given when the patient is 
lying down. 

Anacrotic. Vibrations in the 
pulse-beat; marked on the upward 
line by the sphygmograph. 

Analgesia. Diminished sensibil¬ 
ity to pain. 

Anasarca. Serum in the tissues ; 
dropsy. 

Anatomy. The knowledge of the 
structure of the body, learnt by dis¬ 
section. Deals with the skeleton, 
muscles, etc., and is generally taught 
in connection with surgical nursing. 

Anemia. A deficiency of red cor¬ 
puscles in the blood, generally ac¬ 
companied by pallor of the face and 
palpitation of the heart. Note the 
dress of the patient—if tight; the 
state of the bowels, and watch for 
albumin. Pills containing iron, 
“ Blaud’s Pills,” are often given. 

Anesthesia. Insensibility to pain. 
Local anesthesia is loss of feeling of a 
limited part of the body produced by 
a spray of the anesthetic. 

Anesthetic. The agent which 
produces insensibility. Before a pa¬ 
tient is put under an anesthetic the 
nurse must see that there is nothing 
in the mouth (false teeth must be re¬ 
moved), and that all clothing is loose. 
No solid food must be taken by the 
patient for 6 or 8 hours before the 
anesthetic is given. Watch if the 
patient becomes livid, or if the breath¬ 
ing becomes shallow and irregular; 
these are dangerous symptoms. 

Aneurysm. A dilatation of an ar¬ 
tery. The treatment aims at produc¬ 
ing coagulation of the blood in the 
aneurysm, as a rule. The nurse may 
be called upon to apply digital com¬ 
pression—compression by the fin¬ 
gers. Sudden death is frequent in 
these cases, and the nurse has to keep 
the patient absolutely at rest. 

Angina Pectoris. A sense of suf¬ 
focation, with pain at the heart. The 
attack is sudden ; the patient must 
not be left alone, and the prescribed 
remedies must always be at hand. 

Ankylosis. An immovable state 
of a joint. 

Anodyne. A remedy to procure 
relief from pain, such as opium. 


371 

Anorexia. Lack of appetite, ab¬ 
horrence of food. 

Anteflexion. A bending forward, 
as of the uterus, in which case an in¬ 
trauterine stem, or uterine sound may 
be passed. 

Anthelmintic. Applied to reme¬ 
dies for expulsion of intestinal worms. 

Anthrax. A carbuncle or malig¬ 
nant boil. Charbon anthrax is con¬ 
tracted from animals, and is fatal in 
30 per cent, of cases. The pustule 
is generally excised. 

Anthypnotic. An agent to pre¬ 
vent sleep. 

Antidote. The corrective to a 
poison; thus alkalies are given in cases 
of poisoning by acids. 

Antifebrin. Against fever; an 
agent composed of anilin and gla¬ 
cial acetic acid, used to reduce tem¬ 
perature. Caution : may cause alarm¬ 
ing symptoms. 

Antimony. A salt used as a car¬ 
diac depressant and to promote per¬ 
spiration. Poison. Antidote, tea or 
tannic acid. 

Antiperiodic. An agent to prevent 
the regular return of certain symp¬ 
toms. Thus quinin is used in ague as 
an antiperiodic. 

Antiphlogistic. Relieving inflam¬ 
mation. 

Antipyretic. A remedy for high 
temperature. 

Antipyrin. A drug, used in the 
form of a white powder, to reduce 
high temperature. It begins to act 
in 15 minutes. Causes perspiration, 
and, in rare cases, cardiac weakness. 
Caution: may cause alarming symp¬ 
toms. 

Antisepsis. Exclusion of the germs 
that cause putrefaction; the totality 
of measures taken to prevent septic 
poisoning. 

Antiseptic. Against putrefaction. 
A nurse has much to do with the 
proper use of antiseptics, especially 
in surgical cases, where, if putre¬ 
faction starts in a wound, there is 
great danger. Iodoform, carbolic 
acid, corrosive sublimate, salicylic 
acid, chlorine, terebene, eucalyptus, 
thymol, and Condy’s fluid are the 
commonest antiseptics. Strict atten¬ 
tion must be paid to all orders given 




372 


APPENDIX. 


in connection with the use of these 
agents, and in every case a nurse 
must rinse her hands in some disin¬ 
fectant both before and after dress¬ 
ing a wound. The antiseptic spray 
is an apparatus consisting of a lamp, 
boiler, and jar containing the car¬ 
bolic acid, used to throw a spray 
during operations, or the dressing 
of wounds. 

Antitoxin. A substance or serum 
used to counteract a disease by sub¬ 
cutaneous injection. 

Antrum. A cave ; applied to the 
maxillary sinus, etc. 

Anuria. Suppression of urine. 

Anus. The lower termination of 
the rectum, the opening through 
which fecal matter is discharged. An 
artificial anus is an opening made 
into some higher portion of the in¬ 
testinal canal, when for some reason 
the proper anus is absent or useless. 
The operation to make an artificial 
anus is colostomy. 

Aorta. The large artery rising 
from the left side of the heart, and 
supplying blood to the whole body. 

Aortic Valve. The upper valve on 
the right side of the heart. 

Aperient. A mild purgative medi¬ 
cine, such as cascara, usually given 
at bed-time. 

Aphasia. Speechlessness, often 
caused by cerebral lesion. 

Aphonia. Loss of voice, due to 
fault in the vocal cords. 

Aphthae. Small white ulcers in 
the mouth ; a disease of infants. The 
nurse must watch for intestinal de¬ 
rangement. The mouth of the infant 
must be cleansed with borax, or with 
some similar preparation, after each 
nursing. 

Apnea. Suspended respiration. 
Sometimes seen in chloroform an¬ 
esthesia, and in the newborn. 

Apoplexy. Sudden insensibility 
from pressure on the brain. Paraly¬ 
sis of one side of the body, stertor¬ 
ous breathing. The patient is kept 
recumbent, with ice to the head, and 
a purgative is usually given. Note 
if the pulse grows weak and the sur¬ 
face cold. Great variations of tem¬ 
perature, with giddiness, may point 
to another fit coming on. 


Appendicitis. Inflammation of 

the vermiform appendix. 

Appendix Vermiformis. A rudi¬ 
ment of the lengthened cecum ; or, 
according to Darwin, a relic of the 
lower form of life from which we 
have sprung. Inflammation of the 
vermiform appendix occurs in typhli¬ 
tis, and may lead to peritonitis. Re¬ 
lapse must be watched for. Surgical 
interference often has to be resorted 
to, and, in some cases, laparotomy is 
performed, and the appendix re¬ 
moved. 

Application. The act of applying 
anything, as a plaster, bandage, etc. 

Apyrexia. An intermission of 
fever. 

Aqua. Water : the abbreviation is 
aq., while aq. bull, stands for boiling 
water; aq. dest., distilled water; and 
aq. mar., for sea water. 

Aqua Fortis. Nitric acid. A 
powerful corrosive used in testing. 
Must be used with care, for if it 
comes in contact with the fingers it 
causes a burn. Antidotes: magne¬ 
sia, milk. 

Areola. The brown circle about 
the nipple of the breast. 

Areometer. An instrument for 
measuring the specific gravity of 
fluids ; a hydrometer. 

Armpit. (See Axilla.) 

Arnica. A cardiac stimulant. 
Tincture of arnica is used for bruises 
as a local stimulant. 

Arsenic. A poison: given fre¬ 
quently, in the shape of a white 
powder, in skin diseases. Should be 
given after food. Report at once if 
the tongue gets a white fur, or diar¬ 
rhea or gastric pains commence. 
Antidotes for overdose: magnesia, 
with tincture of iron, chalk and 
water, milk. 

Arteries. Tube-like vessels through 
which the blood is propelled by the 
heart to the peripheral organs. (See 
Axillary, Brachial, Femoral, and 
Tibial.) 

Arteritis. Inflammation of the 

arteries. 

Artery. A tube which conveys 
the purified blood from the heart to 
the capillaries. Bleeding from an 
artery is bright red, and flows in 



GL OSSAR Y. 


373 


jets. A nurse should know the points 
at which it is possible to arrest bleed¬ 
ing by pressure on the artery; in 
every case this point is nearer the 
heart than the site of injury. In am¬ 
putation, etc., the severed arteries are 
tied with ligatures of silk or of catgut. 

Arthritis. Gout; inflammation 
of the joints. 

Articular. Relating to the joints. 

Articulation. A joint or juncture 
of bones ; the mechanism of jointing. 
The articulation of a skeleton is the 
manner in which the bones are joined 
together. The movable articulations 
of the bones are of various forms : 

1. Those in which the bones glide 
upon plane surfaces, as in the articu¬ 
lation of the fibula with the tibia; 

2. Those articulations known as “ ball- 
and-socket joints,” such as the hip- 
joint ; 3. Those having a hinge-like 
articulation, with a forward and back¬ 
ward motion only, as the knee-joint. 
Applied also to the distinct enuncia¬ 
tion of articulate speech. 

Arytenoid. The name of two 
funnel-shaped cartilages and two 
glands of the larynx. 

Asafetida. An antispasmodic, 
chiefly given in hysteria. Strong un¬ 
pleasant smell. 

Ascaris. A genus of worm found 
in the human body. Ascaris lumbri- 
coides, long round worm;- ascaris 
vermicularis, thread-worm. 

Ascites. Dropsy of the abdomen. 

Aseptic. Free from putrefaction. 
In aseptic surgery all instruments, 
dressings, etc., are sterilized by heat 
before use. 

Asphyxia. Pulselessness; sus¬ 
pended animation, particularly from 
suffocation, as in the newborn. 

Aspiration. The operation of 
drawing off fluids from the body 
by means of an aspirator: this 
instrument consists of a hollow 
exploring needle fixed to a tube, 
which connects it with a bottle ; the 
bottle in its turn is connected with 
an exhausting pump. There are two 
stop-cocks at the head of the bottle, 
one to each connection. The air in the 
bottle is exhausted, and the needle is 
plunged into that part of the body 
where the fluid is congregated. The 


duty of the nurse is to have a second 
bottle at hand in case the first is not 
large enough to contain all the fluid, 
and to measure and note the amount 
of fluid withdrawn. She should also 
have ready a flannel bandage, 12 
inches broad, lint, sticking-plaster, 
hot water, sponges, pins, and brandy. 
After-treatment: rest, light stimulat¬ 
ing diet. 

Assimilation. The process of 
transforming food into such a nutri¬ 
ent condition that it is taken up by 
the circulatory system. 

Asthenia. Failure of strength, 
debility. 

Asthma. A disease marked by 
paroxysms of difficult breathing, 
with sense of suffocation. Asthma is 
generally chronic, and not dangerous 
till other complications ensue. The 
duty of the nurse is to have any in¬ 
halations or medicines ordered always 
at hand, in case an attack comes on : 
also to note the sputum. The patient 
must be kept strictly to the diet 
ordered, as this has great effect in 
mitigating the spasms. 

Astigmatism. Inequality in the 
refractive power of the eye. 

Astragalus. The ankle bone. 

Astringent. A medicine causing 
contraction and arresting the flow 
of secretions. 

Ataxy. Irregularity; applied to 
locomotion, to the pulse, and to cer¬ 
tain fevers. 

Atony. Wanting in tone or vigor; 

weakness. 

Atresia. Absence of a natural 
passage. 

Atrium. The portion of the auricle 
of the heart that receives the venous 
blood. 

Atrophy. Wasting; one limb or 
organ of the body is often afflicted 
with atrophy without the other parts 
suffering. 

Atropin. The active principle of 
belladonna. Used as a sedative in 
asthma, neuralgia, spasms, etc., and 
hypodermatically to check sweating, 
etc. Applied to the eye, it soothes 
and causes enlargement of the pupil. 
It is a poison. Antidotes: sulphate 
of zinc as an emetic, ammonia, and 
stimulants. 






374 


APPENDIX. 


Audiphone. A fan-shaped instru¬ 
ment held against the teeth to in¬ 
crease hearing, via the cranial bones. 

Auditory Canal. The passage ex¬ 
tending from the external ear to the 
tympanic membrane. 

Aura Epileptica. A peculiar sen¬ 
sation, like a current of air rising 
from the limbs or body to the head, 
ushering in an epileptic attack. 

Auricle. The external ear; the 
two uppermost chambers of the heart 
are called, respectively, the “left” 
and “ right” auricles. A small gold 
instrument worn in the ear to aid 
hearing is also termed an auricle. 

Auriscope. An instrument fitted 
with a speculum for examining the 
internal ear. 

Auscultation. Listening to sounds 
of the body for the purpose of diag¬ 
nosis. For immediate auscultation the 
ear is placed directly against the body, 
for mediate auscultation a stethoscope 
is used. The sounds heard are called 
“rales,” and are either—(i) crepi¬ 
tus, (2) mucous, (3) sonorous, (4) si¬ 
bilant, or (5) crackling. A nurse 
should learn to use the stethoscope 
by personal application; she will 
then know the normal sounds of the 
heart: a sound like that of gentle 
breathing is heard with the impulse 
of the heart, there is a short, sharp 
sound as the heart falls back, and 
then a pause; then the first long 
sound comes again. A nurse should 
also be able to note the crackling 
sound of the lungs in pneumonia. 

Autopsy. A post-mortem exam¬ 
ination or examination after death. 

Axilla. The cavity beneath the 
upper part of the arm at its junction 
with the shoulder. 

Axillary Artery. The artery of 
the armpit, connecting the subcla¬ 
vian and brachial arteries. 

B. 

Bacillus. A genus of bacteria; 
the comma bacillus is the germ of 
cholera. 

Backbone. The vertebral column ; 
spine. 

Bacteria. Rod-like microbes sup¬ 
posed to infect the blood with differ¬ 


ent diseases. They are unicellular 
and of fungous growth. 

Bag of Waters. The membranes 
enclosing the liquor amnii as they 
project through the os uteri in the 
first stage of labor. 

Baking Soda. Sodium bicarbon¬ 
ate ; saleratus. 

Ballottement. The falling back 
of the fetus when pushed upward by 
the finger; a sign of mid-pregnancy. 

Balneum. A bath, abbreviated to 
bain. Tepidum, warm, or 85° to 95 0 
Fahr., immersion for fourteen min¬ 
utes. Calidum, hot, or 98° to 105° 
Fahr., immersion for ten minutes. 
Frigidum , cold, or 6o° to 70° Fahr., 
immersion for five minutes. A nurse 
must always prepare the bath before 
the patient is put into it, and always 
use the bath-thermometer. The tem¬ 
perature of a vapor-bath may rise as 
high as iio° Fahr. 

Balsam of Peru. Used to heal 
slight scratches, etc., especially 
cracked nipples. 

Bandages. The usual form of 
bandage is the roller, or long strip 
of linen rolled tightly into a cylin¬ 
drical form. The arm bandage 
should be 2 inches wide and 6 yards 
long ; the leg bandage, 3 inches wide 
and 8 yards long; the rib bandage, 6 
inches wide and 6 yards long. The 
triangular bandage is the shape of a 
large handkerchief folded with two 
opposite points together. The T- 
bandage is formed of two pieces of 
roller bandage, the one being tacked 
to the centre of the other, so that 
they look like a capital T. Bandages 
are made of calico, flannel, or do- 
mette, the last a light, open, woollen, 
material. India-rubber bandages are 
used for ulcers and other surgical 
cases. The nurse must learn by 
practice to apply all bandages neatly 
and so as to give equal pressure (see 
p. 158). 

Bath. See page 81 for the different 
varieties of baths. 

Bath-thermometer. A Fahren¬ 
heit tube mounted in a wooden or a 
metal frame for immersion in water 
to ascertain its temperature. 

Battery. A collection of jars for 
generating electricity. 




GLOSSARY. 


375 


Bearing-down. The feeling of 
weight or pressure in the pelvis in 
certain diseases. Bearing-down pains 
are uterine pains during labor. 

Bed. The couch or support on 
which the body may rest in sleep and 
in sickness. (For the different forms 
and varieties of beds, see p. 32.) 

Bed-cradle. A semicircular ap¬ 
paratus to prevent the contact of the 
bed-clothes with a diseased or an in¬ 
jured part. 

Bed-pan. A large shallow vessel 
for receiving the fecal and urinary 
discharges from bedridden patients. 

Bed-rest. An apparatus for prop¬ 
ping up patients in bed. 

Bed-sore. A sore caused on the 
buttocks, heels, or shoulders by con¬ 
stant pressure on the bed. Bed-sores 
arise in long illnesses if the nurse is 
not very careful. If a case is likely 
to be a long one, each morning after 
washing the patient, rub some spirit, 
such as methylated spirit or whisky, 
on the parts of the skin which show 
redness, particularly the lower part 
of the back, then dust with powdered 
starch. Change the patient's position 
as often as possible. It is a sign of 
bad nursing when bed-sores appear, 
and they must immediately be re¬ 
ported to the doctor, who will prob¬ 
ably order zinc dressing, and have 
the patient put on a water-pillow. 

Belladonna. A drug used to 
soothe pain ; to check sweating and 
the secretion of milk. (See Atropin.) 

Benzoic Acid. An alterative and 
expectorant. Given chiefly in liver 
cases. 

Beri-beri. An acute Indian dis¬ 
ease, causing great weakness, an¬ 
emia, and dropsy. 

Bile. The secretion of the liver ; 
greenish, bitter, and viscid. To test 
for biliary coloring matter , pour a 
few drops of the urine on a white 
plate, and add a few drops of nitric 
acid, when, if the coloring matter be 
present, a play of colors—violet, 
green, and red—will occur. 

Bilious. A term applied to diges¬ 
tive disturbance arising from irregu¬ 
lar biliary secretion. 

Binder. A broad band passed 
tightly round the abdomen after 


| childbirth. An ordinary round towel, 
or a piece of flannel 1% yds. in 
length and 18 in. in breadth, will do 
’ for the mother. The infant needs 
a fine flannel or twilled binder, 4 
inches broad and long enough to go 
well round the body and overlap. 

Biparous. Bearing twins. 

Birth. The delivery of a child ; 
parturition. Plural birth, the birth 
of more than a single child; posth'u- 
mous birth, the birth of a child after 
the death of its father; premature 
birth, expulsion of a viable fetus be¬ 
fore full term ; still-birth, a child born 
lifeless. 

Birth-mark. A patch of congeni¬ 
tal discoloration of the skin due to a 
dilated condition of the capillaries. 
“ Mother’s mark.” 

Bismuth. Stomachic sedative and 
tonic. Causes black stools. Over¬ 
dose poisons. 

Bistoury. A small surgical knife, 
usually curved, for making incisions. 

Bladder. The sac which holds the 
urine. Sudden injury to the bladder, 
such as rupture, is generally followed 
by shock. To procure perfect rest 
for the patient and to measure the 
urine are points for special attention 
from the nurse. The Latin term for 
the bladder is vesica. 

Bland. A term applied to mild 
and soothing medicines and applica¬ 
tions. 

Bleeding. (See Hemorrhage.') 

Blind-spot. Point where the optic 
nerve enters the retina : it is abso¬ 
lutely blind. 

Blister. An agent producing a 
vesicle containing serum ; usually a 
blistering fluid, or a plaster (can- 
tharides). The nurse generally is 
entrusted to apply the blister; the 
part must first be washed with soap 
and warm water, and the plaster fas¬ 
tened lightly with a bandage, or, if 
fluid is used, outline the spot with 
olive oil to prevent the fluid spread¬ 
ing ; paint on with a camel’s-hair 
brush. A blister takes from six to 
twelve hours to rise. To dress, snip 
the most pendant part of the bleb, 
and let the serum run out into a re¬ 
ceiver, or a bunch of absorbent cot¬ 
ton. Apply the ointment ordered. 




376 


APPENDIX. 


A perpetual blister is a blister kept 
open for a longer or shorter time by 
means of appropriate dressings. 

Blood. The fluid that circulates 
through the heart, arteries, and 
veins. Arterial blood, “ red blood,” 
so called because contained in the 
arteries ; ve?ious blood, that contained 
in the veins. 

Blood-casts. Microscopic fila¬ 
ments of coagulated blood found in" 
the urine. 

Blood-clot. The coagulum, or 
jelly-like mass formed in blood when 
exposed to the air. 

Blood-current. The “ flow ” of 
the blood through the arteries and 
veins. 

Blood-poisoning. A term denot¬ 
ing any ailment arising from the in¬ 
troduction of decomposing organic 
matter or putrefactive germs into the 
blood. (See Pyemia and Septicemia.) 

Blood-serum. A yellowish, thin 
fluid constituent of blood, separating 
from the blood-clot or fibrin in coag¬ 
ulation. 

Blood-vessels. Tube-like struc¬ 
tures for conveying the blood through¬ 
out the body. 

Boil. Popular name for a small 
tumor or furunculus. 

Bone-repair. The healing of a 
broken bone. (See p. 173.) 

Borax. Boric acid and soda; used 
as an antiseptic, and as a soothing 
drug in diseases of the throat, nares, 
etc. Also to promote catamenial dis¬ 
charge. 

Boric Acid. A mild antiseptic in 
the form of white crystals, used to 
impregnate lint and wool, which are 
colored pink to distinguish them. 

Bougie. A slender instrument for 
dilating contracted passages, made of 
metal, elastic-gum, whalebone, or 
catgut. 

Bouillon. French term for broth. 

Bounding Pulse. A pulse in which 
a weak beat is succeeded by a strong, 
full beat. 

Bowels. (See Intestines .) 

Brachial Artery. The artery of 
the upper arm extending along the 
inner side. 

Brain. The general contents of 
the skull. (See Cerebrum.) 


Breast. The upper anterior part 
of the body between the neck and 
abdomen; also the Ma?nma (q. v.). 

Breast-bone. A flat, oblong bone 
at the anterior part of the thorax. 

Breast-pump. An instrument for 
drawing the milk out of the breast. 

Breath. The air exhaled from the 
lungs; applied also to the act of in¬ 
spiration. 

Breathing. (See Respiration.) Ab¬ 
dominal breathing is that in which the 
abdominal walls move decidedly and 
in which the diaphragm is actively 
engaged ; thoracic breathing is respi¬ 
ration in which the thoracic walls are 
actively moved. 

Bregma. A space on top of an 
infant's head where the parietal bones 
join the frontal bones. It is diamond¬ 
shaped. 

Bright’s Disease. Disease of the 
kidney, associated with albuminuria 
and often with dropsy. The treat¬ 
ment may include vapor baths, hot 
packs, cupping, sponging, the injec¬ 
tion of pilocarpin, and other methods 
of increasing perspiration, which the 
nurse must attend to. The urine 
must be measured, tested for albu¬ 
min and examined for casts and epi¬ 
thelium. The diet ordered must be 
strictly adhered to. Convulsions 
should be watched for. 

Broad Ligaments. The suspen¬ 
sory or broad ligament of the liver. 
Also the suspensory ligaments of the 
uterus. 

Bromidrosis. Offensive sweating 
most common in the feet. Cork soles 
should be worn, and the stockings 
dusted with boric acid. 

Bromids. In large doses are val¬ 
uable hypnotics, in small doses they 
lessen cerebral excitement. They 
consist of a combination of bromin 
with potassium, sodium, or ammo¬ 
nium. In epilepsy, bromidof potas¬ 
sium is found very useful. 

Bronchise. The bronchial tubes 
or air-tubes between the larynx and 
the lungs. 

Bronchitis. Inflammation of the 
bronchial tubes; it may be either 
chronic or acute. (See p. 242.) 

Bronchocele. Enlargement of the 
thyroid gland ; goitre. 





GLOSSARY. 377 


Bruit. The French for “sound” 
and used with regard to the sounds 
heard in auscultation. Bruit de 
braquement, crackling; de diable, 
humming ; de frottement , friction ; de 
pot fete, cracked-pot; de rape , rasp¬ 
ing ; de soiifflet, bellows sound. 

Bryonia. A drug extracted from 
the roots of bryony. Purgative; 
acts also on the kidneys. 

Bubo. Swelling of the groin with 
suppuration; generally syphilitic, 
and therefore to be approached with 
care by the nurse. Old dressings to 
be burnt at once, and forceps only to 
be used in removing them. 

Buchu. Drug used as a diuretic 
and antacid. 

Burnett’s Fluid. A solution of 
chlorid of zinc used as a disinfectant. 
Poison. 

Burns. Any severe burn or scald 
is usually followed by collapse, and for 
this the nurse must watch. Conges¬ 
tion of the internal organs may fol¬ 
low if the patient rallies from the first 
shock. In changing the dressings 
only a small piece of the injured sur¬ 
face must be exposed to the air at 
once, hence the dressing is usually in 
strips. Whiting and water, olive oil, 
or immersion in water, are the usual 
means of excluding the air. Skin- 
grafting may be performed subse¬ 
quently to assist in starting granula¬ 
tion. The smell of a burn is very 
disagreeable, but can to a certain 
extent be overcome by the use of 
some simple cologne. 

Buttocks. The nates, or fleshy 
part of the body posterior to the hip- 
joints, formed by the masses of the 
glutei muscles. 

C. 

Cacao Butter. A pure white fat 
derived from the fixed oil of the 
chocolate tree. It has a pleasant 
odor and taste, and is used largely in 
making suppositories. 

Cachexia. Depraved habit of the 
body. 

Cadaver. A dead body. 

Caffein. The alkaloid of coffee ; 
a cerebral stimulant and powerful 
diuretic. Sometimes given hypo- 


dermatically for headaches and neu¬ 
ralgia. • 

Calabar Bean. A spinal sedative 
and depressant. The alkaloid is 
called “ physostigmin ” and is used 
as an antiseptic in ophthalmic cases. 
It contracts the pupil. 

Calculus. A concretion found in 
the various reservoirs of the body, 
usually called “stone” or “gravel.” 
It is most common in the bladder, 
and the operations for the removal 
or crushing of the stone are lithot¬ 
omy, lithotrity, and litholapaxy 
(which see). 

Calendar Month. The calendar 
or solar month is the twelfth part of 
the year — to 30 days, 10 hours, 29 
minutes. The lunar month is the 
interval from one new moon to an¬ 
other = to 29 days, 12 hours, 44 min¬ 
utes. 

Callous. Hard, insensible, thick¬ 
ened. 

Callus. The new material formed 
when a fractured bone unites. 

Calomel. Subchlorid of mercury. 
An alterative and purgative, used 
specially in bilious cases and in in¬ 
fantile diarrhea. Sometimes used as 
an ointment in skin diseases. Watch 
for mercurialism. 

Caloric. Heat. 

Camphor. A volatile oil, used 
both internally (sometimes causes 
alarming symptoms) and externally as 
a stimulant. 

Canal. A term applied to any 
passage of the body other than ducts 
of glands, blood-vessels, and air-pas¬ 
sages. (See Auditory Canal , p. 374, 
and Alimentary Canal , p. 370.) 

Cancer. A malignant growth, a 
tumor. The only sure cure is by 
operation, and then there is the risk 
of recurrence of the disease in a 
fresh part. In cancer of the uterus 
the operation is hysterectomy. Can¬ 
cer takes three forms : Scirrhous , or 
hard cancer, most common in the 
breast; encephaloid , or soft cancer, 
usually internal; epithelial cancer, 
most common in the lip. Soft can¬ 
cer may be fatal in a few months; 
hard-cancer patients may live for 
years. The nurse has often to tend 
cancer patients; the treatment con- 





378 


APPENDIX. 


sists of extreme cleanliness, and such ■ 
methods of relieving pain as the physi¬ 
cian orders. The smell of cancer is 
often very offensive. 

Cancrum Oris. Ulceration of the 
mouth in ill-fed children. 

Cannabis Indica. Indian hemp, 
hashish; a soporific. 

Cannula. Surgical name for a 
metal tube, such as that employed in 
the operation of tapping. 

Cantharides. Dried Spanish flies, 
used to produce blisters. 

Caoutchouc. India-rubber. 

Capillaries. The minute blood¬ 
vessels connecting the veins and ar¬ 
teries. 

Capsicum. Cayenne pepper; a 
useful stimulant. 

Capsule. A small usually ovoid 
case or shell, made in two parts fitting 
together, and composed of gelatin, 
for administering nauseous medicines. 

Carbolic Acid. A powerful anti¬ 
septic produced from coal-tar. In 
its pure state it is called “ phenol.” 
Taken internally in large doses it is a 
poison, and the antidotes are pow¬ 
dered chalk, milk, and alkaloids. 
Carbolic acid may be absorbed into 
the system when it is used as a dress¬ 
ing ; the nurse generally first discovers 
this by the urine, which, on standing, 
turns a very dark green. This must 
be reported to the doctor. Carbolic 
lotion is used for the hands at the 
strength of 1:40; for the spray, for 
moistening pads, etc., at the strength 
of 1: 20. Nine parts of acid to one 
of glycerin is used as a caustic. Cau¬ 
tion: Several deaths have occurred 
from nurses leaving carbolic acid j 
within the patient’s reach. If possi¬ 
ble keep it under lock and key. 

Carbonate. Compound of car¬ 
bonic acid and a base. 

Carbonis Ligni. Charcoal. Given 
for chronic diarrhea and dyspepsia. 

Carbuncle. Severe inflammation 
of a piece of the skin and adjacent 
tissue; a large and painful boil. The 
patient’s diet will need particular 
attention, as carbuncles are a sign 
of weakened constitution ; it is possi¬ 
ble that spray treatment may be 
tried; or the boil may be opened 
and the wound dressed. 


Carcinoma. Cancer. 

Cardiac. Relating to the heart. 

Cardiograph. An instrument 
which records the beating of the 
heart. 

Caries. Decay of the bone, and 
subsequent suppuration. The nurse 
has to secure rest of the diseased 
part, absolute cleanliness of the 
wound, and to note the discharge— 
particularly if it contains pieces of 
bone. 

Carminative. A remedy for flatu¬ 
lence. Dalby's contains opium and 
must be used with caution. 

Carotid. The principal (right and 
left) artery of the neck. 

Carpus. The wrist. 

Carron Oil. Linseed oil and lime- 
water in equal parts ; a dressing used 
for burns. 

Cartilage. Gristle ; a semi-trans¬ 
parent substance of the body, very 
elastic, and softer than bone. 

Caruncle. A small fleshy growth ; 
hence caruncula lachrymalis, the 
small, red globe of the inner corner 
of the eye; and carunculce myrti- 
formes, the granulations round the 
vagina, remnants of the ruptured 
hymen. 

Cascara Sagrada. A mild laxa¬ 
tive. 

Cascarilla. Drug used as an as¬ 
tringent. 

Case. A single instance or exam¬ 
ple of a disease. 

Case-taking. The chief points 
are—(1) History of the previous 
health of the patient, his occupation, 
his habits of life ; (2) history of the 
l present illness from the very first 
symptoms; (3) history of the pa¬ 
tient’s family, particularly with refer¬ 
ence to hereditary tendencies ; (4) the 
patient’s condition at the time of tak¬ 
ing the case. 

Casein. An albuminate component 
of milk. 

Castile Soap. Soap made from 
olive oil. 

Castor Oil. An aperient medicine 
of unpleasant taste. It is best ad¬ 
ministered to adults in coffee or in 
brandy and water. Pour some cof¬ 
fee into a cup and shake the cup so 
that the sides are wet with coffee; 






GLOSSARY. 


379 


pour the oil into the centre of the 
coffee; make the patient open the 
lips widely and let the oil pass well 
to the back of the throat. Give a 
drink of pure coffee just before and 
just after the oil. For children, 
powder a dessertspoon with pulver¬ 
ized sugar, pour in the oil, powder 
its surface with sugar. Give a drink 
of milk just before and just after the 
oil. Usual dose: teaspoonful for a 
child ; 54 to i ounce for an adult. 

Casts. A cast is a fibrous or plas¬ 
tic mass that has taken the form of 
some cavity in which it has been 
moulded. Casts are either intesti¬ 
nal, nasal, renal, tracheal, etc., ac¬ 
cording to their source ; and epithe¬ 
lial, fatty, fibrinous, granular, mu¬ 
cous, etc., according to their consti¬ 
tution. (See Blood-casts , Epithelial 
Casts, and Renal Casts.) 

Catalepsy. A disease producing 
periods of trance, during which the 
limbs remain in any position in which 
they are placed. A pinch of snuff to 
the nostrils will sometimes break the 
trance. A nurse for these cases must 
have considerable moral strength. 

Cataplasm. A poultice. 

Cataract. Opacity of the lens of 
the eye, causing blindness if not re¬ 
moved. The operation is usually iri¬ 
dectomy. The nurse has to secure 
perfect rest to the patient in a dark¬ 
ened room. Probably atropin, co- 
cain, or some other drug will have 
to be dropped into the eye at inter¬ 
vals. 

Catarrh. Inflammation of the 
mucous membrane, generally applied 
to the nose and throat, but also to 
the internal organs at times. Thus 
we hear of “ gastric catarrh.” An 
ordinary cold in the head is nasal 
catarrh. Inhalations may be neces¬ 
sary. 

Catechu. An astringent, given 

chiefly in diarrhea and dysentery. 

Catgut. The intestines of a sheep 
treated to make ligatures. 

Cathartic. A purging medicine, 
such as senna. 

Catheter. An instrument for with¬ 
drawing water from the bladder; 
made either of silver, india-rubber, 
silk-elastic, or whalebone. When 


not in use, the instrument should 
be kept in i : 20 carbolic solution ; 
just before and just after using, it 
should be washed through with a 
stream of warm water. The method 
of passing the catheter can only be 
learned by practice. 

Cathode. In electricity, the part 
immediately touching the negative 
pole. 

Caul. The membranes about the 
head and face of an infant at birth. 

Caustic. A substance which burns 
living tissue. The most common 
form is nitrate of silver, pointed like 
a pencil, and held in a metal clip. 
The nurse must be careful to keep 
the caustic covered, and, in using it, 
must only touch the prescribed area. 
Perchlorid of iron and sulphate of 
copper are slightly caustic. 

Cauterize. To sear or burn with 
a cautery or a caustic. 

Cautery. The actual cautery is 
the application of heated metal to 
living tissue. Cautery irons are of 
different shapes, and consist of a 
straight piece of iron fixed in a han¬ 
dle ; the tip of the iron is either a 
point, a button, or a bulb. They are 
heated in the fire till red; if then 
lightly touched on a bleeding sur¬ 
face will arrest hemorrhage. Gal- 
vano-cautery is burning the tissues 
with a wire made hot by electricity. 
Potential cautery is burning the flesh 
by means of chemicals. Thermo-cau¬ 
tery is the cauterization of flesh by 
means of heat generated on galvanic 
principles. The galvano-cautery and 
the thermo-cautery are now largely 
replacing the actual cautery. 

Cavity. A hollow, either normal, 
as the abdomen, chest, etc., or abnor¬ 
mal, as a pulmonary or a dental 
cavity. 

Cayenne Pepper. (See Capsicum!) 

Cecum. A “ blind pouch ” or cul- 
de-sac, about 2 Yi inches long, situated 
between the termination of the ileum 
and commencement of the large in¬ 
testine. The structure and relations 
of the cecum render it peculiarly lia¬ 
ble to two forms of disorder—accu¬ 
mulation of the contents of the ali¬ 
mentary canal and inflammation. 

Cellular. Relating to or com- 





380 


APPENDIX. 


posed of cells. Cellular tissue is the 
network connecting the majority of 
the minute parts of the body. 

Centigrade. French method of 
marking temperature ; the freezing 
point is o°, the boiling point ioo°. 
(See Temperature .) 

Centigramme. The one-hundredth 
of a gramme, nearly equal to 0.16 part 
of a grain avoirdupois. 

Centimetre. Cubic centimetre , writ¬ 
ten cc., and used in foreign prescrip¬ 
tions, equals 16 minims. 

Cephalalgia. Pain in the head ; 
“ cephalo ” is used to compound 
many terms; thus, cephalometer, an 
instrument for measuring the head. 

Cephalhematoma. A bloody tu¬ 
mor on the head of an infant. 

Cephalotribe. An instrument con¬ 
sisting of two blades and a screw, 
used to crush the fetal head. 

Cerate. A greasy substance con¬ 
sisting of wax mixed with oils, fatty 
substances, or resins, and of such 
consistence that at ordinary tempera¬ 
tures it can readily be spread upon 
linen or muslin, and yet is so firm 
that it will not melt or run when ap¬ 
plied to the skin. 

Cerebellum. The little brain at 
the back of the head, between the 
cerebrum and the medulla oblongata. 

Cerebral. Relating to the brain. 

Cerebrum. The big brain, occu¬ 
pying the cranium. 

Cerumen. Waxy secretion of the 
ear. 

Cervix. The neck. 

Cervix Uteri. The neck of the 
uterus. 

Cesarean Section. An abdominal 
incision for extracting the fetus from 
the uterus. It was first performed 
successfully on a woman in 1498. 

Chafing. Excoriations, abrasions, 
and inflammation produced by fric¬ 
tion of parts, or between the folds of 
the skin, etc. 

Chalybeate. Containing iron. 

Chamomile. Antispasmodic med¬ 
icine. 

Charcoal. Prescribed as a medi¬ 
cine in dyspepsia, and generally given 
as tabloids. A charcoal poultice is 
made of equal parts of flaxseed meal 
and powdered charcoal. 


Charpie. Unravelled, shredded, 
linen, used for dressing wounds. 

Chart. A ruled sheet of paper on 
which the nurse records the tempera¬ 
ture, pulse, motions, etc., of a pa¬ 
tient. 

Chartse. Papers on which medici¬ 
nal substances are spread. Thus, 
Charice sinapis, a leaf of mustard- 
paper. 

Chattering. The noise made by 
the teeth striking together repeatedly 
and rapidly, as under the influence 
of cold or of fright. 

Cheese-cloth. A coarse cotton 
fabric of an open texture ; ordinarily 
used in cheese-making for wrapping 
the cheese. 

Chest. (See T horax.) 

Cheyne- Stokes Breathing. Ir¬ 
regular respiration consisting of ten 
or fifteen short breaths and then a 
long pause. A bad symptom. 

Chicken-pox. Varicella. Rash 
appears on the chest about the third 
day ; the disease runs its course in a 
fortnight. Give light food and keep 
from cold; prevent the patient from 
scratching the pimples, or scars will 
be made. Infectious. 

Chilblain. A blain or sore pro¬ 
duced by cold; an erythematous 
condition of the hands or feet, ac¬ 
companied with inflammation, pain, 
and sometimes ulceration. 

Childbirth. The act of bringing 
forth a child. 

Chill. A sensation of cold accom¬ 
panied by shivering, usually appear¬ 
ing shortly after exposure to cold 01- 
wet. It is usually the first symptom 
of grave acute disorders, as pneu¬ 
monia ; and is a prominent symptom 
of various forms of malarial fever. 
(See Rigorl) 

Chiropodist. One skilled in cut¬ 
ting and extracting corns. 

Chirurgical. Surgical. 

Chloral. White opaque hypnotic. 
Antidote for overdose, fresh air, am¬ 
monia, artificial respiration. 

Chlorine. Antiseptic. Used as a 
lotion for sores; also as a gargle, in¬ 
halation, etc. 

Chloroform. A colorless liquid 
used to produce anesthesia by in¬ 
halation. Chloroform must always 






GLOSSARY. 


be kept in the dark. The private 
nurse has sometimes to administer 
chloroform ; a simple inhaler is made 
of a small wire mask over which a 
piece of flannel is stretched, or a few 
drops of chloroform can be sprinkled 
on a towel and held close to the pa¬ 
tient's face. Chloroform is only safe 
when mixed with air; so at intervals 
the towel must be removed and the 
patient allowed a breath of air. Un¬ 
consciousness is reached when all the 
muscles are relaxed, and the patient's 
hand drops when raised. The eye¬ 
ball should never be touched, as it 
may cause inflammation. Many 
cases have been known through this 
practice of the etherizer. Antidote 
for an overdose, fresh air and arti¬ 
ficial respiration. If the nurse is ad¬ 
ministering the chloroform, she must 
be very careful to watch the respira¬ 
tion of the patient. Before the anes¬ 
thetic is administered, false teeth and 
tight clothing must be removed. No 
solid meal must be given for six hours 
before the operation, but a little beef- 
tea may be given two hours before. 
After the operation the nurse must 
be prepared for the vomiting which 
is usual. 

Chlorosis. A peculiar form of 
anemia common in females about the 
period of puberty. It causes weak¬ 
ness, rapid heart-action on exertion, 
and faintness, for all of which a nurse 
must be prepared. It is generally 
met by iron tonics, sea-air, and 
strengthening diet. 

Cholagogues. Agents which de¬ 
crease the bile in the blood. 

Cholera. An epidemic disease. 
Symptoms: Cramp, vomiting, and 
rice-water evacuations. “ English ” 
cholera is the mild form; “Asiatic” 
is the severe form. Much depends 
upon the nursing; the patient must 
be kept warm and recumbent, medi¬ 
cines for the alleviation of pain must 
be given promptly. The great dan¬ 
ger is from collapse. The patient 
should, if possible, be placed in a 
separate room. Only the persons in 
attendance should enter the room. 
If the apartment should not allow of 
sufficient isolation, the patient should 
be removed to a hospital. Those who 


381 

are in continued attendance upon 
choleraic patients, or who live with 
them, should obey the following 
rules: Neither food nor drink should 
be taken in a room occupied by a 
patient. The mouth should be care¬ 
fully rinsed before each meal, and the 
hands and forearms washed with a 
solution of borax. The face, head, 
and hands, and, if possible, the whole 
body, should be washed daily with 
water containing 160 grains of borax. 
The disease runs its course swiftly, 
and has been fatal in India in a few 
hours. 

Cholera Infantum. Summer diar¬ 
rhea of infants ; it requires immediate 
attention, or prostration soon comes 
on. Diet is of the utmost importance, 
also freedom from chills. 

Cholera Morbus. An acute ca¬ 
tarrhal inflammation of the mucous 
membrane of the stomach and intes¬ 
tines, with enteric pain, purging, 
vomiting, spasmodic contractions of 
the muscles, etc. It is a summer 
disease. 

Chorea. St. Vitus' dance : invol¬ 
untary twitchings of the muscles; 
most common in children, who gen¬ 
erally grow out of it. These cases 
must not be left alone, and every 
effort must be made to prevent chil¬ 
dren from hurting themselves. Diet 
nourishing. Baths and gymnastic 
exercises may be ordered. 

Chorion. The vascular and outer 
envelope of the fetus. 

Chronic. A term applied to a dis¬ 
ease that is protracted. 

Chyle. The milk-like fluid into 
which food is transformed before it 
is aborbed into the blood. 

Chyluria. Milk-like urine. 

Chyme. The pulpy mass of food 
which passes from the stomach into 
the intestines. 

Cicatrix. The scar of a healed 
wound or ulcer. 

Cilia. Eye-lashes. 

Cinchona. Peruvian bark, which 
yields quinin. A tonic, and a valu¬ 
able medicine in malarial fevers for 
reducing the ranges of temperature. 

Cinnamon. Sometimes given as 
an astringent. 

Circulation. The movements of 





382 


APPENDIX. 


the blood from the heart, through 
the arteries, veins, and capillaries 
back to the heart (see p. 287). 

Circumcision. The removal of a 
circular piece of the prepuce ; gen¬ 
erally performed on young children. 
The child has to be kept very quiet 
for some days, and very clean. 

Cirrhosis. Contracted granular 
state of an organ, usually applied to 
the liver or the lung. A cirrhous 
liver is generally produced by drink. 

Cirsoid. Resembling a varix. 

Citrate. Compound of citric acid 
and a base. 

Citric Acid. Acid prepared from 
lemon-juice. Makes an astringent 
yet soothing lotion. 

Clavicle. The collar-bone, going 
from each shoulder to the breast¬ 
bone across the front of the chest. 
Fractured clavicle is set by a firm 
pad, 4 or 5 inches square, placed in 
the axilla, the forearm is bandaged 
over the chest, and the point of the 
elbow kept well back. No anesthetic 
needed as a rule. 

Clavus. A corn ; a thickening of 
the skin, common on the toes. 

Cleft Palate. A congenital split 
in the roof of the mouth, so that the 
nose and mouth form one cavity. 
The child must be sat upright when 
fed, and a long teat employed, and 
the milk poured slowly to the back 
of the throat. It cannot suck, as it 
cannot create a vacuum, and the 
milk is liable to return down the 
nose. Operation usually takes place 
about two or three years of age. 

Climacteric. The cessation of 
menstruation in females; often a 
critical period, when the health 
needs great attention. 

Clinic. Bedside. 

Clinical Thermometer. A slender 
glass instrument used to discover the 
temperature of the body. (See Tem¬ 
perature.') 

Clitoris. A small organ of erec¬ 
tile tissue, found in the female in 
front of the pubes. The seat of sex¬ 
ual excitement. 

Clonic. Spasmodic contractions, 
short and frequent. 

Clot of Blood. A thickened mass 
of blood. See Embolism. 


Cloves. The dried flower-buds of 
the clove tree. Cloves are largely 
used as a spice, and in medicine for 
their stimulant and aromatic proper¬ 
ties. 

Club-foot. Talipes. A congenital 
turning of the foot in a wrong direc¬ 
tion. Generally necessitates the 
wearing by the child of a light splint, 
which may effect a cure. Massage 
is useful in the case of infants. 

Clyster. An enema, or injection 
per anus. 

Coagulation. Thickening of a 
fluid into curds. 

Cocain. A powerful local anes¬ 
thetic, much used by oculists and 
dentists. It enlarges the pupil of the 
eye. Useful to stay the craving for 
opium or drink. The hypodermatic 
injection of cocain produces severe 
symptoms in some people, and anti¬ 
dotes (amyl nitrite and morphin) 
should always be at hand. 

Cocainism. Chronic poisoning 
from indulgence in the drug. 

Coccyx. The tail-like termination 
of the spine. 

Cochlea. The cavity of the inter¬ 
nal ear. 

Codein. A preparation of opium, 
used to soothe the nerves and in¬ 
duce sleep. It allays cough, and is 
useful in diabetes, etc. 

Cod-liver Oil. A medicine used 
as a restorative and nutritive, particu¬ 
larly in consumption cases. It ought 
to cause the patient to increase in 
weight. It should be given after 
food, plain, if the patient will take it; 
if not, floated in milk, coffee, or or¬ 
ange-juice. 

Colchicum. A drug used in gout; 
it reduces the blood-pressure, and 
lessons muscular irritability. Poison. 

Colic. Severe pain in the belly; 
generally allayed by hot fomenta¬ 
tions. 

Colitis. Inflammation of the colon. 
Poultices, opium injections, or mor¬ 
phia suppositories. In membranous 
colitis or enteritis casts are passed 
from the bowel. 

Collapse. Severe sudden prostra¬ 
tion. Symptoms : pallor, faintness of 
pulse, unconsciousness. Treatment: 
lay patient perfectly flat, keep warm, 



GLOSSARY. 


383 


give sal volatile or alcohol in small 
doses, watch the pulse. Hypoder¬ 
matic injection of brandy may be 
necessary in severe cases, or even 
artificial respiration, if the breathing 
actually stops. 

Collar Bone. (See Clavicle.) 

Collodion. Gun-cotton dissolved 
in alcohol and used in surgery to form 
a false skin. When painted over a 
commencing bed-sore, for instance, it 
hardens as it dries, and forms a 
slight protection to the tender skin. 
The stopper must never be kept out 
of the collodion bottle for more than 
a moment. 

Colocynth. A drug used as a 
rapid and drastic purge. 

Colon. The part of the large in¬ 
testine between the rectum and the 
cecum. 

Colostrum. A watery fluid flow¬ 
ing from the breasts the first two or 
three days after confinement, before 
the true milk comes. 

Colotomy. Incision of the colon ; 
a serious operation which may be 
performed in the lumbar or inguinal 
regions, in cases of fistula, obstruc¬ 
tion, cancer, or ulceration of the 
rectum. 

Coma. Insensibility, stupor, sleep. 

Comatose. In a state of coma. 

Comedones. Sebaceous secretions 
of the hair-follicles, commonly called 
“ black-heads," and most frequent on 
the face. 

Complication. The occurrence 
during the course of a disease of 
some other affection, or of some 
modifying symptom, or group of 
symptoms not ordinarily observed. 

Compress. A tightly folded pad 
of linen used to secure local pressure. 

Conception. The impregnation 
of the ovum. 

Concretions. Bony deposits; cal¬ 
culi. 

Concussion of the Brain. Sud¬ 
den interruption of the functions of 
the brain, and consequent uncon¬ 
sciousness, through a blow or fall. 
Rest and quiet are necessary, and 
the application of cold to the head 
and warmth to the extremities. In 
mild cases consciousness returns in 
from a few minutes to a few hours. 


Inflammation of the brain may fol¬ 
low if proper quiet is not obtained. 

Condyle. A round projection at 
the ends of some bones. 

Condy’s Fluid. A valuable anti¬ 
septic. prepared from permanganate 
of potash. Often used by the monthly 
nurse when syringing is ordered for 
her patient. 

Confectiones. Soft pastes contain¬ 
ing drugs. 

Confinement. The condition of 
women during childbirth. 

Confluent. A term applied to 
eruptions in which the pustules run 
together. 

Congenital. Existing at birth. 
Congenital diseases or deformities are 
those present at birth. 

Congestion. Torpid stagnation 
of blood in a part of the body, as in 
the lungs or brain. Congestion of the 
lungs is brought on by chill, and the 
nursing treatment is warmth, rest, 
flaxseed-meal poultice to the affected 
part, and light diet. The tempera¬ 
ture must be taken twice in the twenty- 
four hours, as inflammation often 
follows as the result of the conges¬ 
tion. Congestion of the brain is a 
term sometimes applied to brain 
fever, apoplectic strokes, or any form 
of delirium ; quiet, darkness, and 
careful attention to the doctor’s 
orders are necessary. 

Conium. Hemlock, a poisonous 
drug which quiets muscular action, 
also the central nervous system. 
Used specially in cases of mania, or 
ovarian pain. Antidotes : Stomach- 
pump, stimulants, tannin. 

Conjunctiva. The mucous mem¬ 
brane of the eye. 

Conjunctivitis. Inflammation of 
the membrane of the eye, ophthal¬ 
mia (which see). 

Constipation. A confined state 
of the bowels; the nurse must always 
report to the doctor when no action 
of the bowels takes place in twenty- 
four hours. The remedies are usu¬ 
ally either an enema or a laxative 
medicine. 

Consumption. A wasting away, 
caused by disease of the lungs. (See 
Phthisis.) 

Contagious. Spreading by touch ; 





3§4 


APPENDIX. 


a contagious disease can only be 
caught by those who come into di¬ 
rect contact with the patient; it is 
not communicable through the at¬ 
mosphere. 

Continued Fever. A simple febrile 
attack, which runs its course unin¬ 
terrupted by any attempt at treat¬ 
ment. The patient must be kept 
recumbent, cool, and fed on light 
diet. Note temperature. 

Contraction. The act of drawing 
together or shrinking. 

Contra-indication. An indica¬ 
tion against a remedy or method of 
treatment. 

Contusion. A bruise. 

Convalescence. The period of 
returning strength after an illness. 
The nurse needs to amuse her pa¬ 
tient, prevent rash deeds, or fatigue 
arising from too many visitors ; sup¬ 
ply light nutritive food at frequent 
intervals; avoid all talk about the 
past illness, and watch for a relapse. 

Convolutions. The folds and 
twists of the brain or the intestines. 

Convulsions. Violent spasms of 
alternate muscular contraction and 
relaxation, common in infants, and 
usually the result of too strong diet 
or of costiveness. Clonic convulsion 
is applied to spasmodic movements 
of short duration and alternate 
periods of relaxation, as in epilepsy. 
Tonic convulsion signifies a constant 
rigidity. Uremic is due to the altered 
state of the blood in diseases of the 
kidney. Convulsions occur in epi¬ 
lepsy, tetanus, hydrophobia, and 
chorea. (See Eclampsia.') 

Copaiba. A diuretic; the oleo- 
resin is also given in capsules for 
ascarides, etc. 

Cord. The connection between 
mother and child at birth; after 
washing the infant, the remnant of 
the cord should be dressed with pow¬ 
dered starch, and a square of anti¬ 
septic gauze. 

Core. The central slough or sub¬ 
stance of a boil or carbuncle, formed 
of dead tissue. 

Coriaceous. Of rough texture, 

coarse. 

Corium. The internal layer of the 
skin. 


Cornea. The clear, glass-like front 
of the eyeball. 

Corn Starch. A flour made from 
the starchy parts of Indian corn, 
used for puddings, etc. 

Coronal Suture. The joint of 
the parietal and frontal bones of the 
skull. 

Corpora Lutea. Yellow bodies in 
the ovarium. 

Corpuscle. A minute protoplasmic 
body—for instance, the red and white 
corpuscles of the blood. 

Corrective. A drug which modi¬ 
fies the action of another drug. 

Corrosive. Eating into, consum¬ 
ing. 

Corrosive Sublimate. Bichlorid 
of mercury. Antiseptic ; poisonous. 
The solution i in 1000 is very useful 
in infectious fevers; it is seldom used 
for instruments, as it corrodes steel. 
Antidotes : flour, milk, white of egg. 

Coryza. Cold in the head, nasal 
catarrh, 

Costal. Relating to the ribs. 

Costive. Constipation. 

Cotton. The white fibre obtained 
from the cotton-plant ( Gossypium ). 
Absorbent cotton is the fibre prepared 
by removal of oily matters for use in 
surgical operations, etc. (See Collo¬ 
dion. Antiseptic cotton.) 

Cotton-wool. (See Cotton.) 

Cough. Violent, sonorous expira¬ 
tion after closure of the glottis. 
Hacking cough is a short, broken, dry 
cough. 

Counter-extension. Extension by 
means of holding back the upper 
part of a limb while the lower is 
pulled down. 

Counter-irritants. The drugs used 
to produce counter-irritation (q. s.), 
called rubefacients, epipastics, vesi¬ 
cants or blistering agents, and pustu- 
lants. 

Counter-irritation. Causing irri¬ 
tation of one part of the body to re¬ 
lieve another; also called “ deriva¬ 
tion ” and “ revulsion.” 

Coxalgia. Pain in the hip-joint. 
(See Hip-joint.) 

Coxitis. Inflammation of the hip- 
joint. 

Cradle. A series of small wooden 
arches used to keep the bedclothes 





GLOSSAR Y. 


385 


from pressing on the injured part of 
the body. 

Cramp. Sudden and violent con¬ 
traction of the muscles, causing great 
pain. Friction may give relief. 

Craniotomy. The operation of 
perforating the head of the fetus dur¬ 
ing parturition, crushing it, and re¬ 
moving the fragments. 

Cranium. The skull. 

Cravat. A bandage of triangular 
shape, used as a temporary dressing 
for a wound or a fracture. (See 
Bandage .) 

Creolin. A drug nearly related to 
carbolic acid; antiseptic and disin¬ 
fectant. 

Creosote. An oily antiseptic 
liquid got from wood-tar. Used as 
an inhalation in phthisis, and as a 
remedy for toothache; also as a 
styptic, an antispasmodic, and an al¬ 
terative. Gives the urine a blackish 
color. 

Crepitation. The grating sound 
of two ends of a fractured bone rub¬ 
bing together. Also a grating sound 
heard on auscultation in cases of 
pneumonia. 

Cretinism. Imperfect mental fac¬ 
ulties, often accompanied by goitre. 
Most common in Switzerland. 

Crisis. The deciding point of a 
disease, from which the patient either 
begins to recover or sinks rapidly ; 
often marked by a long sleep, pro¬ 
fuse perspiration or other phenome¬ 
non. 

Crotchet. A hooked instrument 
used to extract remnants of the fetus 
after embryotomy. 

Croton Oil. Used as a liniment 
and as a swift purge; causes red 
eruption on the skin. Poison. 

Croup. Acute inflammation of the 
larynx and trachea, most common in 
young children. A nurse should 
know the breathlessness, restlessness, 
and crowing sound which are pre¬ 
monitory symptoms of croup; for a 
child may suffocate if attention is not 
immediate. 

Crural. Relating to the thigh. 

Cumulative. Increasing; adding 
to. Cumulative action , the produc¬ 
tion of a noteworthy and sudden re¬ 
sult, after the administration of a 

25 


considerable number of compara¬ 
tively ineffective doses. The possible 
cumulative effect of certain drugs is 
one of the sources of danger that at¬ 
tend their administration. 

Cupping. Blistering or bleeding 
by means of bell-shaped glasses. Put 
a few drops of spirit of wine in the 
glass and swirl it round till the inside 
is moist to the brim. A plug of cot- 
ton-wool on a stick should then be 
dipped in the spirit, lighted, and 
passed quickly round the glass; this 
will produce a large momentary 
flame, and the glass must be imme¬ 
diately pressed on the desired place— 
usually the nape of the neck. The 
flame will have created a vacuum in 
the glass, which will cause an imme¬ 
diate rising of the skin. So far it is 
dry cupping; if it is wet cupping that 
is ordered, the glasses are removed, 
numerous small incisions are made 
in the risen skin, and the glass is re¬ 
placed (after having been exhausted 
again), and a steady flow of blood 
will soon fill the glass. The wound 
can be dressed with some simple 
ointment on a piece of lint. 

Cupri Sulphas. Sulphate of cop¬ 
per. An astringent and ■ emetic. 
Poison. 

Curette. A spoon-shaped instru¬ 
ment used in operations. 

Cutaneous. Pertaining to the skin. 

Cuticle. The external, or scarf 
skin. 

Cutis. The derma or true skin. 

Cyanosis. Blue disease, a con¬ 
gestion of the venous system so that 
the blue blood of the veins discolors 
the skin. 

Cyst. A tumor containing fluid, 
or semi-fluid, in a membranous sac. 

Cystalgia. Pain in the bladder. 

Cystitis. Inflammation orcatarrh 
of the bladder; often chronic. The 
nurse will have to measure and test 
urine, and probably give douches. If 
obstinate, perineal incision in the 
male, or colpocystotomy in the fe¬ 
male, may have to be performed. 

Cystocele. Protrusion of the 
bladder. 

Cystoscope. An instrument for 
examining the bladder; sometimes 
lighted by electricity. 




3 86 


APPENDIX. 


Cystotome. A surgical instrument 
used in operations on the lens of the 
eye and on the bladder. 

Cystotomy. Incision of the blad¬ 
der; for the removal of stones, or for 
drainage. The nurse must watch in 
case peritonitis supervenes. 

D. 

Dead. The laying out of the dead 
is the nurse’s duty ; the eyes must be 
closed by gentle pressure of the 
fingers, the jaw must be tied up by 
a bandage passing under the chin 
and tied on the top of the head. The 
body must be washed all over one 
hour after death, orifices packed with 
cotton-wool, and clean garments put 
on (see p. 261). 

Debilitants. Remedies which re¬ 
duce excitement. 

Debility. Weakness, loss of 
power. 

Decidua. A spongy membrane 
produced in the womb by concep¬ 
tion, and thrown off after parturition. 

Decoction. The extract obtained 
from any substance by boiling. 

Decomposition. Putrefaction. 

Decussation. An X-like crossing, 
especially of nerves or of nerve-like 
filaments. 

Defecation. The act of evacuating 
the bowels. 

Deformity. Abnormal shape or 
structure of a body or any of its 
parts. 

Degeneration. Abnormal changes 
in the tissues. Amyloid degeneration 
is that of the tissues of blood-vessels, 
spleen, liver, etc., which became wax¬ 
like. Fatty degeneration is when the 
muscular fibres degenerate into fat, 
and thus become incapable of work. 
A term used especially of the muscles 
of the heart. 

Deglutition. Act of swallowing. 

Dejections. The fecal or other 
excrementitious matters discharged 
by the body. 

Delirium. Extravagant talking, 
raving, generally due to high fever. 
The nurse must watch the patient 
carefully, as he is as irresponsible for 
his deeds as for his words, and may 
escape from bed, or even commit sui¬ 


cide. Too often a patient has com¬ 
mitted suicide “ in the absence of the 
nurse." The nurse should never be 
absent, at least without leaving some 
one in charge. 

Delirium Tremens. Mania-a- 
potu. The trembling delirium due to 
excessive use of alcoholic liquors. 
The patient must be humored and 
soothed in every way, and watched 
incessantly. Collapse must be ap¬ 
prehended. 

Delivery. Parturition ; childbirth. 
Post-mortem delivery is the birth of a 
fetus after the death of the mother, 
from an accumulation of gases in the 
uterus. 

Deltoid. The muscle which forms 
the prominence of the shoulder. 

Demarcation. A line of separa¬ 
tion, as between healthy and gan¬ 
grenous tissue. 

Dementia. Feebleness of the 
mental faculties, inconsequent ideas. 

Demulcents. Agents which pro¬ 
tect sensitive surfaces from irrita¬ 
tion. 

Dentaphone. A little hollow in¬ 
strument placed on the teeth to assist 
hearing. 

Dentine. The tissue which forms 
the body of a tooth. 

Dentition. Teething; infants have 
20 teeth : 8 incisors in front, 4 canine 
between, and 8 molars at the back. 
The incisors are cut first, in the 
seventh month as a rule ; at two 
years a 41 the teeth should be present. 
During teething the gums become 
swollen ; the child must be kept from 
catching cold ; diarrhea, convulsions, 
and rashes must be watched for; the 
temperature should be taken every 
evening. (See also Teeth.) 

Deodorant. A substance that will 
remove or correct offensive odors, as 
chlorin, chlorid of lime, quicklime, 
etc. 

Deodorizer. Destroyer of smells ; 
the chief deodorants are chlorid of 
lime, sulphurous acid, nitrous acid, 
and iodoform. They are all more 
or less disinfectants. 

Depilatory. An agent for remov¬ 
ing superfluous hairs from the body. 

Depletion. Act of emptying; 
bleeding; purging. 



GLOSSARY. 



Depressant. A medicine which 
reduces the beatings of the heart. 

Depression. A low or depressed 
physical or mental condition. In 
surgery, displacement inward of the 
skull, often giving rise to pressure 
on the brain. 

Dermatitis. Inflammation of the 
skin. 

Desquamation. Peeling off of the 
skin. After scarlet fever the period 
of desquamation is the most infec¬ 
tious, and care must be taken that the 
cast skin is not allowed to blow about. 

Desudation. Excessive sweating. 

Detergents. Fluids used for 
cleansing wounds and ulcers. 

Determination. Excessive flow 
of blood to a part. 

Detritus. The waste of tissue, 
worn away by disorganization. 

Development. Growth; progres¬ 
sive variation toward mature or per¬ 
fected condition. 

Diabetes. A disease marked by 
an excessive flow of saccharine urine. 
The treatment almost entirely consists 
of attention to diet: sweets, pudding, 
pastry, potatoes, and bread have to 
be avoided ; meat, fish, eggs, butter, 
cheese, and green vegetables are 
allowed. The nurse will have to 
measure and test urine ; the quantity 
may be as much as 4 or 5 quarts in 24 
hours; the specific gravity may be 
as high as 1040; the urine in diabetes 
turns Fehling’s solution yellowish- 
brown. Diabetes insipidus , character¬ 
ized by a greatly increased flow of 
urine of a low specific gravity, asso¬ 
ciated with a marked degree of thirst. 
The urine is pale, almost colorless, 
and with a specific gravity but slightly 
above that of water. Many of the 
cases progressively emaciate and 
finally die of exhaustion. Diabetes 
7 nellitus (see Glycosuria ). 

Diagnosis. The decision as to the 
exact nature of an illness, arrived at 
by studying the symptoms. 

Diaphoresis. Perspiration. 

Diaphoretics. Agents which in¬ 
crease perspiration. 

Diaphragm. The muscle separat¬ 
ing the chest from the abdomen. 

Diaphysis. The middle part of 
long bones. 


Diarrhea. Frequent loose evacua¬ 
tions of the bowels. Very weakening. 
Diarrhea should immediately be re¬ 
ported to the doctor, and the evac¬ 
uations kept for inspection. It is 
especially dangerous in children, 
being liable to become chronic. 
Whenever diarrhea is present it is 
necessary to give great attention to 
the diet; see that it is light, easily 
digestible, and suitable to the age and 
illness of the patient. Milk and lime- 
water, and barley-water are alone 
allowed in serious cases. 

Diastole. The dilatation of the 
heart and arteries; opposite to sys¬ 
tole. 

Diathesis. Constitutional disposi¬ 
tion to certain diseases. 

Dicrotic. An apparent double 
beat of the pulse. 

Diet. System of food. As a rule, 
full diet consists of an ample allow¬ 
ance of meat, bread, vegetables, pud¬ 
dings, etc.; middle diet , of mutton, 
fish, bread, milk puddings, and eggs 
in moderate quantities; fever , or 
“light” diet, of beef-tea, chicken- 
broth, and milk; no solids. 

Digestion. The process of con¬ 
verting the food eaten into chyme 
and chyle, so that it can be absorbed 
into the blood. 

Digestive. Relating to or favor¬ 
ing digestion. The digestive or gas¬ 
tric juices are the normal secretions 
of the glands of the stomach. 

Digital. Pertaining to the fingers. 

Digitalis. A drug extracted from 
the foxglove, and used to stimulate 
the action of the heart. It causes 
decrease of pulse-rate, and increase 
of urine. Poison. Marked intermit- 
tence of pulse to be immediately re¬ 
ported. 

Dilatation. Increase in size, en¬ 
largement. 

Diluents. Medicines supposed to 
increase the fluidity of the blood. 

Diphtheria. Infectious inflamma¬ 
tion of the throat, with formation of 
false membrane, which tends to close 
up the throat and cause suffocation. 
The earlier symptoms of diphtheria 
are like those of a heavy cold; the 
temperature does not run very high. 
Grayish-white patches appear on the 



3 88 


APPENDIX. 


tonsils and on the interior of the 
throat; this is the false membrane. 
The patient should be isolated, and 
thorough disinfection of everything 
used about the patient carried out. 
The nurse must be careful never to 
inhale the patient’s breath. In severe 
cases, where suffocation is imminent, 
tracheotomy or intubation may be 
performed. Death may be due to 
blood-poisoning, sudden heart-fail¬ 
ure (permit no exertion on the part 
of the patient), or secondary pneu¬ 
monia, as well as to suffocation. 

Diplopia. Seeing double. 

Dipsomania. An irresistible mania 
for drink, occurring at regular inter¬ 
vals. The nurse-attendant in these 
cases has a hard time; the general 
health of the patient must be attended 
to, he must never be allowed to get 
hungry or thirsty. Strong coffee 
and salt-beef tea should be given 
frequently. 

Director. A grooved surgical in¬ 
strument used to guide another in¬ 
strument. 

Disarticulation. Amputation at 
a joint. 

Discharge. Flowing out; emis¬ 
sion of matter evacuated. 

Disinfectants. Agents which de¬ 
stroy disease germs: such as heat, 
carbolic acid, sulphur, chlorine, 
etc. 

Disinfection. (See Fumigation.') 

Dislocation. Displacement of a 
bone out of its socket. An anesthetic is 
not usually necessary for the operation 
of reducing a dislocation; all that 
will be needed will be two or three 
bandages, two or three long towels, 
and some powdered starch. After¬ 
ward the patient must be kept quiet. 
Compound dislocation , rupture of the 
coverings of a joint and communi¬ 
cating with the air. Simple dislocation , 
without laceration of surrounding 
parts. 

Disorder. A slight form of dis¬ 
ease. Functional disorder is an un¬ 
explainable disorder in the working 
of an organ. 

Dispensing. The mixing and pre¬ 
paring of drugs sometimes falls to 
the lot of a nurse; it needs special 
training. 


Dissection. The cutting up of 
dead bodies for the purpose of study. 

Dissolution. A term for death. 

Distal Aspect. Aspect away from 
the centre of the body. 

Distention. The state of being 
stretched or dilated; inflation. 

Distortion. A deformity or mal¬ 
formation, acquired or congenital. 
Also, a writhing or twisting motion, 
as of the face. 

Diuresis. Increased flow of urine. 

Diuretics. Medicines which cause 
an increased flow of the urine. 

Dizziness. (See Vertigo.) 

Donovan’s Solution. Contains 
mercury and arsenic. Give after 
meals. 

Dorsal. Relating to the back. 

Dorsum. The back. 

Dose. The quantity of a medicine 
which when taken will produce thera¬ 
peutic effect. 

Douche. A shower of water. Hot 
douche ii2° F., cold douche 50° F. 

Dover’s Powder. A favorite sed¬ 
ative medicine of which the chief in¬ 
gredients are ipecacuanha and opium. 
It increases perspiration. 

Drachm. Weight of 60 grains, or 
in fluid measure 60 minims (about 
one teaspoonful). 

Drainage - tubes. India-rubber 
tubes of different sizes for inserting 
in suppurating wounds and sores. 
When not in use, they should be kept 
in 1 : 40 carbolic solution in glass jars. 
When used they are snipped up and 
down each side, and a safety-pin or 
some long threads of silk are put at 
the mouth, to keep the tube from 
slipping out of sight into the wound. 

Drastic. Strong, severe. 

Dressing. The cleansing and ap¬ 
plying of healing remedies to a 
wound. A nurse must always have 
ready the applications for a dressing 
before the appearance of the surgeon 
or student who is going to perform it. 
Surgical dressings are those applied 
in operations (see p. 176). 

Dropsy. An unnatural effusion of 
watery fluid into the tissues or cavi¬ 
ties of the body. Dropsy has been 
said to be a symptom, not a disease, 
and it frequently sets in toward the 
end in cases of cancer, heart disease, 



GLOSSARY. 


389 


etc. Dropsical patients need the 
greatest care in moving them. The 
operation most likely to be performed 
is aspiration. 

Drown. To deprive of life by im¬ 
mersion in a fluid. 

Drug. Any chemical substance 
(simple or compound) used in the 
treatment of disease. 

Dry Heat. I leat without moisture. 

Duct. A canal or tube ; usually a 
passage through which the secretion 
of a gland empties. The biliary ducts 
are the hepatic, cystic, and com¬ 
munis choledochus ducts of the liver 
and gall-bladder. Lactiferous ducts 
are the canals of the mammary glands. 

Duodenum. The first part of the 
small intestine, beginning at the 
stomach. 

Dura Mater. A strong membrane 
lining the interior of the cranium and 
spinal column. 

Dysentery. Inflammation of the 
intestine, accompanied by bloody 
evacuations. Absolute rest, attention 
to diet, and regular administering of 
remedies. Chills must be avoided. 
Enemas are frequently ordered. The 
motions must be counted and kept 
for inspection, The patient is liable 
to suffer from weakness and depres¬ 
sion. 

Dysmenorrhea. Painful or diffi¬ 
cult menstruation. It may be de¬ 
pendent on anemia, and disappear 
with the cure of the latter; or it 
may be due to causes which require 
surgical interference. If only occa¬ 
sional, hot fomentations to the abdo¬ 
men, hot drinks, and a hot bottle to 
the feet and back may give relief. 

Dyspepsia. Indigestion: careful 
attention to diet. Note the condition 
of the tongue and the evacuations. 
Be prepared for irritability and mel¬ 
ancholy on the part of the patient. 

Dysphagia. Difficulty in swallow¬ 
ing. 

Dysphasia. Difficulty in speak¬ 
ing. 

Dysphrasia. Loss of power to 
speak the words wanted. 

Dyspnea. Difficult breathing. 

Dystocia. A difficult labor. 

Dysuria. Difficult discharge of 
the urine. 


E. 

Eau. Water ; eau-de-vie is ardent 
spirit. 

Ecchondroma. A tumor on the 

cartilage. 

Ecchymosis. A bruise ; an effu¬ 
sion of blood under the skin. 

Eclampsia. Serious puerperal 
convulsions, with rapid motions of 
eyes, mouth, and fingers. 

Ecraseur. An instrument for re¬ 
moving piles, malignant growths, etc. 

Eczema. An eruption on the skin ; 
not contagious, but very unpleasant, 
and causing great irritation. The 
local remedies are often left to the 
nurse to apply; washing is to be 
avoided as a rule, and no soap used. 
To remove crusts, soak with oil, or 
apply poultices; some dusting-pow¬ 
der will probably be ordered. For the 
face, ointment, as a rule, is applied 
on a mask of lint. Children’s hands 
must be gloved or tied to their sides, 
to prevent scratching. A chill will 
increase the disease in children. 

Edema. Swelling of a dropsical 
nature ; when the finger is pressed on 
the part affected the flesh pits and 
does not regain its color and form for 
some seconds. In case-taking any 
edema should be noted. 

Effervescent. A fizzing medicine. 

Effleurage. A massage movement, 
light and gentle, between stroking 
and friction, done with the finger 
tips. 

Effusion. A flow of fluid into 
tissues. 

Elaterium. A drastic purge some¬ 
times given in dropsy. May cause 
nausea. 

Elbow-joint. The articulation of 
the arm and forearm. 

Electricity. A natural force gen¬ 
erated by chemical action, friction, or 
magnetism. 

Electrode. The point where an 
electric current enters or leaves the 
body. 

Electuary. A concoction of pow¬ 
ders and syrup, making a sweet medi¬ 
cinal draught. 

Elephantiasis. A skin disease, 
causing terrible enlargement of the 
limb or limbs affected. It is chronic ; 



39 ° 


APPENDIX. 


the skin thickens until it somewhat 
resembles an elephant's hide. 

Elevator. A muscle which raises 
a limb. 

Elixir. A term sometimes applied 
to certain tinctures having a sweet 
taste. 

Emaciation. General thinness of 
the body. 

Embolism. Coagulation of blood 
into an embolus, or clot, and conse¬ 
quent obstruction. There is always 
the danger of the clot passing to the 
heart in these cases, and causing sud¬ 
den death. 

Embrocation. A lotion for rub¬ 
bing on to the body. 

Embryo. Term for the fetus be¬ 
fore it has quickened. 

Emergency. A sudden, pressing, 
and unforeseen occasion for action. 
An accident or condition unlooked 
for, and calling for prompt decision. 

Emesis. Vomiting, 

Emetic. Any means used to pro¬ 
duce vomiting, Tickling the throat 
with a feather; large draughts of 
tepid water, salt water, or mustard 
and water, will produce the desired 
effect. 

Emmenagogue. A medicine which 
promotes the flow of the menses. 

Emollients. Softening and sooth¬ 
ing applications or liniments. 

Emphysema. Swelling produced 
by air, as dropsy is caused by liquid. 

Empiricism. Treatment founded 
on experience only, not on learn- 
ing. 

Emplastrum. A plaster. 

Emprosthotonos. Spasms caus¬ 
ing the body to bend forward. 

Empyema. A collection of pus in 
one or both of the cavities of the 
pleura. 

Emulsion. A mixture of oil, such 
as cod-liver oil, with water, by aid of 
gum, etc. 

Enamel. The hard outer coating 
of the tooth. 

Encephalocele. Protrusion of the 
brain through the skull. 

Encephalon. The brain. 

Encysted. Tumors contained in 
a sac or cyst. 

Endarteritis. Inflammation of 
the lining membrane of the arteries. 


Endemic. A disease prevalent in 
a particular locality. 

Endocarditis. Inflammation of 
the lining membrane of the heart. 
Often occurs after rheumatism or 
renal disease; seldom directly fatal. 

Endocardium. The lining mem¬ 
brane of the heart. 

Endometrium. The lining mem¬ 
brane of the uterus. 

Endothelium. The lining mem¬ 
brane of cavities. 

Enema. A rectal injection for 
medicinal or nutritive purposes. The 
instrument used is commonly a 
syringe, a bulb from which go two 
tubes; one tube has an ivory mouth¬ 
piece, which is inserted into the anus, 
the other is put into the fluid to be 
injected. In administering an enema, 
cause the patient to lie on the left 
side with knees drawn up, have the 
basin containing the enemata on a 
chair by the bed, oil the mouthpiece 
of the syringe, and, standing behind 
the patient, insert it gently: pre¬ 
viously the air should have been 
squeezed out of the syringe and the 
fluid drawn into it. The injecting 
should be done slowly and gently. 
Plural, enemata (see pp. 59-63). 

Enterectomy. Excision of part 
of the intestine; a serious opera¬ 
tion. 

Enteric Fever. (See Typhoid 
Fever .) 

Enteritis. Inflammation of the 
small intestine. A disease accom¬ 
panied by much pain, and needing 
careful nursing. No solid food is 
permitted, and absolute rest in the 
recumbent position is necessary. 

Enterocele. Hernia, consisting of 
a protrusion of the intestine. 

Enterotomy. Opening the peri¬ 
toneal cavity and raising and opening 
the distended bowel. Like all forms 
of intestinal surgery, it is serious, and 
needs careful nursing. 

Entozoa. Parasites living within 
the body. 

Enuresis. Involuntary discharge 
of urine. Give no liquid near bed¬ 
time. 

Epidemic. A disease attacking a 
number of people in the same place 
at one time. Epidemics are usually 




GLOSSARY. 


391 


accounted for by the disease being 
either infectious or contagious. 

Epidermis. The outermost layer 
of the skin. 

Epigastrium. The region over 
the stomach. 

Epiglottis. The thin flaps of car¬ 
tilage which guard the entrance to 
the glottis or windpipe. 

Epilepsy. A disease of the brain 
marked by the occurrence of con¬ 
vulsive fits. Perseverance in treat¬ 
ment is the chief hope of cure, hence 
it behooves nurses or attendants to 
be very patient and careful. A 
slight fit is called petit mat , a severe 
fit grand or haut mat. The fits are 
often brought on by excitement or 
any slight ill-health, lack of attention 
to the bowels, for instance. The 
nurse must note if the fit commences 
with a cry, where the convulsions 
begin, and how they spread, if the 
thumb is flexed, and how long the fits 
last. There is nothing to be done 
for the patient but to put him flat on 
the floor, unloose tight clothing, put 
a cork or pencil between the teeth to 
prevent the tongue being bitten, and 
otherwise prevent him from injuring 
himself. 

Epiphysis. A process of bone at¬ 
tached by cartilage to the ends of 
bones, and from which growth takes 
place. 

Epiploon. The omentum, a mem¬ 
branous expansion which floats upon 
the intestines. 

Episiotomy. Incision of labia in 
difficult parturition. 

Epispastics. Agents applied to 
the skin to produce discharge, such 
as blisters or vesicatories. 

Epistaxis. Bleeding from the 
nose, apt to become serious in debili¬ 
tated or anemic persons. Applica¬ 
tions of ice-bags to the back of the 
neck and to the forehead, or plug the 
nose with lint dipped in vinegar or 
lemon-juice. 

Epithelial Casts. Filaments of 
renal epithelium found in the urine 
in certain diseases, when examined 
under the microscope. They are 
chiefly polygonal, are finely granular, 
and have large nuclei. If in consid¬ 
erable quantity, they signify nephritis 


or some other disease of the kid¬ 
neys. 

Epithelium. The outermost 
bloodless layer of the mucous mem¬ 
brane ; corresponding with the epi¬ 
dermis of the skin. 

Ergot. A drug derived from a 
fungus which grows on rye ; it is used 
especially in labor cases to contract 
the uterus and arrest hemorrhage. It 
prolongs the length and force of pains 
in a paturient uterus. 

Ergotin. A form of ergot specially 
used hypodermatically to arrest 
bleeding. 

Erosion. Ulceration of parts. 

Eructation. Flatulency, with ex¬ 
tension. 

Eruption. A breaking out on the 
skin. 

Erysipelas. Contagious inflam¬ 
mation of the skin, tending to spread, 
accompanied by fever and pain in 
the part affected. It is necessary for 
a surgical nurse to keep watch for 
erysipelas, though, in these days of 
antiseptic surgery, it seldom ap¬ 
pears. The symptoms are redness 
round the edges of the wound, vom¬ 
iting, rigors, and a rise of tempera¬ 
ture—all this must immediately be 
reported to the surgeon. The pa¬ 
tient and nurse are isolated and great 
care must be taken to disinfect all ar¬ 
ticles used. The period of incubation 
for erysipelas is from three to seven 
days; on the second or third day 
after rigor, a diffuse red rash with 
swelling appears. Constitutional ery¬ 
sipelas of the head and face is not 
uncommon. Erysipelas contagion 
produces puerperal fever in parturient 
women. 

Erythema. Non-contagious cir¬ 
cumscribed inflammation of the skin. 
If acute, often followed by rheumatic 
fever. 

Eschar. A dry healing scab on a 
wound ; generally the result of the 
use of caustic. Also the mortified 
part in dry gangrene. 

Esophagus. The canal which runs 
from the throat into the stomach. 

Essences. Strong solutions of one 
part volatile oil in four of rectified 
spirits. Usually given in a few drops 
on sugar. 



39 2 


APPENDIX. 


Ether. A volatile liquid much 
used as an anesthetic. It must never 
be used near an uncovered light, as 
it is very inflammable. Spirits of 
tiitrous ether are diuretic and carmin¬ 
ative. 

Etherization. Anesthesia or un¬ 
consciousness produced by the in¬ 
halation of the vapor of ether. 

Ethmoid. A bone of the nose, 
through which the olfactory nerve 
passes. 

Etiology. The science of the 
causation of disease. 

Eucalyptus. An antiseptic much 
used in catarrhal affections ; it is used 
as an inhalation in phthisis. It is a 
colorless, oily liquid, with a pungent, 
resinous smell. 

Eustachian Tube. The canal from 
the throat to the ear. 

Eustachian Valve. A fold in the 
membrane of the right auricle of the 
heart. 

Evacuation. Discharge of excre¬ 
ment from the body. (See Move¬ 
ments.') 

Eventration. Protrusion of the 
intestines. 

Eversion. Folding outward. 

Exacerbation. A return of fever; 
a paroxysm of disease. 

Exanthemata. Diseases accom¬ 
panied by eruptions or rashes. 

Excision. Act of cutting away. 

Excoriation. Abrasion of the skin. 

Excrescence. An unnatural pro¬ 
truding growth. 

Excreta. The urine and feces. 

Excretion. The throwing off of 
waste matter. 

Exfoliation. Scaling off of a dead 
bone or tissue in thin flakes. 

Exhaustion. Great loss of vital 
and nervous power from fatigue or 
protracted disease. 

Exostosis. A bony tumor grow¬ 
ing from bone. 

Expectant. Treatment which re¬ 
moves obstacles and then watches the 
course of events without using medi¬ 
cinal remedies. 

Expectoration. Secretions from 
chest coughed up. The nurse must 
note the quantity and character of 
the expectoration. In pneumonia it 
is viscid, tenacious, sticks to the sides 


of the sputum-cup, and is of rusty ap¬ 
pearance, or may even be of a prune- 
color ; in bronchitis the expectora¬ 
tion is frothy, abundant, and often 
streaked with black, and of a green¬ 
ish-yellow color, from the presence 
of pus ; in consumption the expectora¬ 
tion varies from a small quantity of 
frothy fluid to abundant greenish- 
yellow offensive phlegm or sputum, 
often streaked with blood. 

Expression. The recognizable 
manifestation through the facial line¬ 
aments or the voice of any subjective 
feeling. 

Expulsion. The act of driving out. 

Extension. A certain pull or 
weight applied to a fractured or dis¬ 
located limb to keep it straight. 

Extensor. A muscle which ex¬ 
tends a part. 

Extirpate. To completely re¬ 
move. 

Extracts. Medicinal preparations 
made by extracting the ingredients 
of vegetable substances, An extract 
is a solid preparation ; a fluid extract 
is a liquid preparation. 

Extra-uterine Gestation. Preg¬ 
nancy outside the uterus ; in the ab¬ 
dominal cavity, for instance. 

Extravasation. Escape of fluid 
from its proper channel into sur¬ 
rounding tissue. 

Extremities. The limbs; the ter¬ 
minal end of an organ. 

Exudation. Oozing ; slow’ escape 
of liquid. 

Eyeball. The globe of the eye. 

Eyes. The organs of vision or 
sight. 

Eye-teeth. The canine teeth (see 
Teeth). 

F. 

Facial. Relating to the face. 

Fahrenheit. The scale of most 
thermometers used in America ; the 
freezing point is 32 0 , the normal heat 
of the human body 98.4°, the boiling 
point 212 0 (see Thermometer). 

Faint. A short swoon. Lay the 
patient flat, and let him have plenty 
of fresh air. Consciousness wall soon 
return. Patients are very' liable to 
faint the first time they are allowed up 






GLOSSARY ,i 


393 


after a long illness, unless the nurse 
is careful strictly to limit the exertion 
allowed. 

Faintness. (See Syncope.) 

Fallopian Tubes. Two trumpet¬ 
like canals, about 3 inches long, 
passing from the womb to the ovaries. 

Faradism. Electricity generated 
by induction. 

Farinaceous. Containing flour or 
grain. Farinaceous diet consists of 
puddings, gruel, bread, etc.; no meat. 

Fascia. The membrane which en¬ 
closes the muscles. 

Fauces. The throat, the back of 
the mouth. 

Favus. A contagious cutaneous 
disease, most common on the scalp. 
It is marked by a honeycombed 
scab. The nurse must be careful 
about disinfection. 

Febrifuge. An agent for allaying 
fever. 

Febrile. Relating to fever. 

Fecal. Relating to the feces. 

Feces. The refuse material ex¬ 
pelled from the bowels by the anus. 

Fecundation. Impregnation. 

Feeble. Lacking strength ; weak. 

Feeding. Artificial feeding is the 
introduction of food into the body 
by artificial means, such as the stom¬ 
ach-pump, or in the form of an 
enema. Also, the nourishing of a 
child by food other than the mother’s 
milk. 

Felon. Whitlow. 

Femoral Artery. The artery of 
the upper leg, from the thigh to the 
knee. 

Femur. The thigh-bone. 

Fenestrum. An aperture or fora¬ 
men, as in certain bones. 

Ferrum. Iron. The most import¬ 
ant of tonics; to be given after food, 
because if given on an empty stomach 
it decomposes the digestive fluid. 

Fester. Inflammation, with col¬ 
lection of pus. 

Fetal Movements. The muscular 
movements of the fetus in utero. 

Fetid. Offensive smelling. 

Fetor. Strong unpleasant smell. 

Fetus. An unborn child, espe¬ 
cially from the fourth month. 

Fever. Disease marked by heat 
of the body, quick pulse, lassitude, 


and often delirium. The nursing 
treatment of every fever is rest, free¬ 
dom from chills, and light nourishing 
diet. 

Fibre. Thread-like structure. Mo¬ 
tor fibres are centrifugal nerve-fibres 
exciting contraction of the muscles. 
Sensory nerve-fibres, centripetal fibres 
conveying sensory impulses to the 
brain. 

Fibrin. Albumin of the blood, 
which solidifies when exposed to the 
air and causes coagulation. 

Fibula. The small bone on the 
outer side of the lower leg. 

Fimbriae. The fringe-like pro¬ 
cesses of the outer extremity of the 
oviduct. 

First Intention. A surgical term 
for healing of a wound by bringing 
the edges directly together, so that 
they unite without the necessity of 
new granulations to fill in spaces. 

Fissure. A term applied to va¬ 
rious grooves of the body. 

Fistula. Any unnatural passage 
by which an internal organ or pus- 
sac communicates with another or 
with the external air. 

Fit. A sudden convulsive attack. 
The nurse must prevent the patient 
from injuring himself, and loosen 
any tight clothing. She must note 
where the spasms commence, how 
they spread, and how long the fit 
lasts. 

Flabby. Deficient in firmness. 

Flatulence. Wind or gas in the 
intestines ; sometimes causing severe 
pain, but as a rule, merely discom¬ 
fort. 

Flexion. Being bent; the oppo¬ 
site to extension. 

Flexor. A muscle which causes 
flexion. 

Floccillation. Carphology. Pick¬ 
ing the bed-clothes: a grave symp¬ 
tom in acute diseases. 

Flooding. Excessive bleeding 
from the uterus during parturition. 
(See Post-partum.) 

Flow. (See Menstruation .) 

Fluor Albus. White discharge 
from the vagina or uterus. 

Flush. A temporary redness, as 
the hectic flush. 

Flux. A flow of liquid. 




394 


APPENDIX. 


Follicle. A minute bag contain¬ 
ing some secretion. (See Graafian .) 

Fomentation. Flannel wrung 
out in some hot fluid and applied 
for the alleviation of pain. The 
flannel should be put in a basin and 
boiling water poured over it, then 
lift it quickly into the centre of a 
towel; catch the towel with one end 
in each hand, twist opposite ways till 
the flannel is well wrung out, apply 
as hot as can be borne, and cover 
with a dry flannel bandage. For a 
turpentine fomentation, sprinkle 20 to 
30 drops of turpentine on the flannel 
immediately before application ; for 
an opium fomentation, sprinkle 15 to 
20 drops of laudanum on in the same 
way. Fomentations need frequent 
changing, every hour or oftener. 

Fontanelle. A soft space in the 
skull bone of an infant before the 
skull has hardened. 

Foramen. A hole; an opening 
into the body. For instance, the 
foramen ovale , which separates the 
left and right auricles in the fetus. 

Forceps. Surgical pincers used 
for lifting and moving instead of 
using the fingers. Dressing forceps 
are shaped like scissors, with blunt, 
flat points; dissecting forceps are 
shaped like sugar-tongs. Every nurse 
should carry forceps, and iise them ; 
they need to be kept clean, and to 
be disinfected always before and 
after use. Obstetric forceps are of 
different sizes and shapes, and are 
used for grasping the head of the 
fetus in difficult labor ; there are also 
many other kinds of forceps. 

Forearm. That part of the arm 
between the wrist and the elbow. 

Forehead. That part of the face 
between the orbits of the eyes, the 
hair above, and the temples. 

Formula. A prescription. 

Fossa. Little depressions of the 
body, such as fossa lacrymalis, the 
hollow of the frontal bone, which 
holds the lachrymal gland. 

Fourchette. The commissure join¬ 
ing the labia majora of the puden¬ 
dum posteriorly. 

Fracture. A broken bone : symp¬ 
toms —crepitus, limb shortened and 
helpless, pain. Keep the limb at 


rest in a natural position between 
sand-bags. For setting a fracture, 
an anesthetic is usually given. Per¬ 
fect rest is the only cure, and the 
nurse must see that it is carried out. 
Colies fracture , a fracture of the 
wrist; comminuted fracture , when the 
bone is splintered ; complicated frac¬ 
ture , some injury is added to the 
fracture : thus fractured ribs may be 
complicated by injury to the lungs ; 
compound fracture, a fracture with an 
open wound from the skin to the 
broken bone ; green-stick , one side 
of the bone being broken, the other 
bent ; impacted , the end of one frag¬ 
ment being firmly driven into the 
tissue of the other; simple, one in 
which the seat of fracture does not 
communicate with the air. 

Friction. Medical rubbing or 
shampooing. Should always be done 
from the extremities toward the heart. 

Frontal. Relating to the fore¬ 
head. 

Frost-bite. Injury to the skin or 
a part of the body from extreme 
cold. 

Fuller’s Earth. Chiefly consists 
of silica, alumina, and oxid of iron. 
Very absorbent. 

Fumigation. The private nurse has 
often to fumigate, or expose to disin¬ 
fecting vapors, a room in which an in¬ 
fectious case has been nursed. When 
the room is vacated a fire should be 
lighted in the fireplace, and all papers, 
old linen, old clothes, and other objects 
of small value, burnt there, if they 
have been contaminated. The chim¬ 
ney, windows, and other openings 
should then be shut, and in the mid¬ 
dle of the room containing the furni¬ 
ture and bedding a pan with some 
live coals should be placed. On the 
coals should be put a layer of sand, 
and on that a quantity of sulphur 
(broken into pieces), proportionate to 
the size of the room, 1 lb. to 1000 
cubic ft. The door should then be 
shut. After being hermetically closed 
and exposed to the sulphur fumes for 
twenty-four hours, the room should 
be fully aired by opening the win¬ 
dows, and must not be again occu¬ 
pied for at least a week after being 
disinfected (see p. 234). 




GLOSSARY 395 


Function. The special work of an 
organ. 

Fundament. The anus. 

Fundus. The base of an organ, 
usually applied to the uterus. 

Fungus. A microscopic, parasitic, 
vegetable growth. 

Funis. The umbilical cord. 

Fur. An unnatural coating of the 
tongue, common in fevers. 

Furunculus. A little boil con¬ 
taining a central core. 

G. 

Galactia. Disorder of the milk- 
secretion. 

Galactorrhea. Excess of milk. 

Gall. A bitter secretion found in 
the gall-bladder. 

Gall-bladder. The membranous 
sac which holds the bile. 

Gall-ducts. Ducts conveying the 
bile. 

Gall-stone. Calculus in the gall¬ 
bladder. If the stone passes into the 
duct and thence to the duodenum, 
there is great pain. Local applica¬ 
tion of heat and injections of morphia 
are usual. Diet important. 

Gallic Acid. An astringent; used 
to control bleeding and lessen the 
night-sweats of phthisis. 

Galvanism. Electricity generated 
by means of a battery of cells with 
carbon and zinc plates in acid solu¬ 
tion. Practically the application of 
continuous currents as distinct from 
alternate currents. 

Ganglion. An enlargement of a 
nerve forming a semi-independent 
nerve-centre. Also swelling of the 
sheath of a tendon. 

Gangrene. Death of a part. It 
begins with discoloration of one of 
the extremities, generally the toes, 
and gradually becomes mortification. 
The hardening of the arteries and 
consequent defective circulation of a 
part in old people sometimes brings 
on a form of dry gangrene called 
“ senile gangrene.” Moist gangrene 
is a form with abundant serous exu¬ 
dation and rapid decomposition. The 
nurse's duty is strict cleanliness ; the 
only cure is amputation. Fresh air 
and nourishing food are necessary. 


Raise the limb. Keep the part warm 
by the aid of hot-water bottles. 

Gargle. A liquid medicine for 
washing out the throat. 

Garrot. An improvised tourni¬ 
quet, consisting of a handkerchief, a 
stone, and a stick. 

Gastralgia. Unpleasant burning 
feeling or acute pain in the stomach 
due to indigestion. 

Gastric. Relating to the stom¬ 
ach. 

Gastric Fever. Fever accompa¬ 
nied by catarrh of the stomach, and 
bearing a close relationship to enteric 
fever, and needing the same care in 
nursing and in diet. 

Gastric Juice. The digestive fluid 
of the stomach. 

Gastritis. Inflammation of the 
stomach. 

Gastrohysterotomy. Opening into 
the uterus through the abdomen, 
i Porro-Cesarean operation. 

Gastrostomy. Making an artificial 
; mouth into the stomach. 

Gauze. Fine tarlatan used as a 
surgical dressing, and generally im¬ 
pregnated with some antiseptic. Car¬ 
bolic gauze, unbleached tarlatan im¬ 
pregnated with carbolic acid, resin, 
and paraffin; usually prepared in 
lengths of 6 yds. by i yd. and used 
in antiseptic dressings. Should be 
kept in a tightly-closed tin box. 

Gavage. Forced feeding. 

Gelsemium. A nerve-soothing 
drug prescribed in tetanus, mania, 
and nervous affections. Contracts 
the pupil. Watch for frontal head¬ 
ache or double vision. Poison. 

Generation. Production of human 
beings. 

Genitalia. The outer generative 
organs, or privates. 

Gentian. A useful drug, very 
bitter, acts as a stomachic tonic. 

Genu Valgum. Knock-knee. 

Germ. A microbe or bacterium. 

Gestation. The period of carry¬ 
ing the young in the womb. 

Giddiness. A sensation of un¬ 
steadiness of the body, usually ac¬ 
companied with more or less nausea. 
(See Vertigo.) 

Ginger. Carminative and stimu¬ 
lant. 





396 


APPENDIX. 


Gingivitis. Inflammation of the 

gums. 

Glanders. A febrile disease with 
inflammation of the nasal cavities, 
communicable to man from the horse, 
ass, and mule. Often fatal. 

Glands. Small bodies occurring 
in different parts of the body and 
having the power of secretion. Con¬ 
catenate glands of the neck, Cowpers 
glands of the prostate, Brunner's 
glands of the duodenum, etc. Cow¬ 
per s glands are two small glands like 
peas above the bulb of the urethra ; 
Lachrymal glands are those which 
secrete the tears; Salivary glands 
are three glands at the back of the 
lower jaw. 

Gians. Bulbous extremity of the 
penis and clitoris. 

Glauber’s Salt. Sulphate of soda, 
a purge. 

Glenoid. A cavity ; a term applied 
to the socket of the shoulder-joint 
and similar parts. 

Globule. A very little pill. 

Globulin. An albuminous con¬ 
stituent of the blood-corpuscles. 

Globus Hystericus. Hysterical 
choking feeling, as of a ball in the 
throat. 

Glonoin. Nitroglycerin; used as 
a drug to accelerate the heart's 
action in angina pectoris, shock, etc. 

Glossitis. Inflammation of the 
tongue. 

Glottis. The opening into the 
windpipe. 

Glycerin. A sweet, colorless 
liquid, obtained from oils and fats. 
Used as an emollient ointment. 
Also in enemata as an aperient; one 
teaspoonful is injected from a special 
piston-syringe. 

Glycosuria. Grape-sugar or glu¬ 
cose in the urine, a symptom in dia¬ 
betes. Sometimes a transitory state 
only. 

Gnathic. Relating to the jaw or 
cheek. 

Goiter. Enlargement of the thy¬ 
roid gland of the throat, common in 
Switzerland, where it is often associ¬ 
ated with cretinism. 

Gonorrhea. Inflammation of the 
genitals and flow of pus. Contagious: 
the nurse must be very careful to 


burn all soiled dressings, and always to 
use forceps. If the patient is a fe¬ 
male, frequent baths and hot douches 
of warm water may be ordered. In¬ 
flammation of the external genitals 
must be watched for. 

Gorget. A blunt grooved instru¬ 
ment used in operations in stone. 

Gouge. A grooved instrument of 
steel or bone used to scoop out dead 
bone. 

Gout. A disease marked by at¬ 
tacks of acute pain and swelling of 
the joints, usually of the big toe or 
the thumb. Chalky concretions form 
about the joints in time. The nurse 
has to attend to the local applications 
(often tincture of opium, iodid of 
potassium, or carbonate of lithia, ap¬ 
plied on charpie and covered with 
oil-silk) ; she has also to see to the 
diet, for dyspepsia generally accom¬ 
panies gout. Hot baths followed 
by passive manipulation may be 
ordered. The urine must be meas¬ 
ured and tested, the presence of 
lithates being specially watched for. 

Graafian Follicles. Small vesicles 
found near the surface of the ovary. 

Grafting. Snipping minute por¬ 
tions of the skin from a healthy part 
and planting them on some sore or 
wound where there is no skin, that 
they may grow there and help the 
wound to heal over. 

Gramme. Unit of metric weight, 
15.5 grains. 

Granulation. The process by 
which tiny granules of flesh form on 
the face of a wound during its heal¬ 
ing. This is healing by second inten¬ 
tion (q. v.). 

Granule. Small particle or grain. 

Grape-sugar. Glucose. 

Gravel. A popular term for stone 
of the bladder and other calculi. 

Gravid. Term applied to the 
womb during gestation. 

Gray Matter. The gray substance 
of the brain. 

Groin. Back of the thigh. 

Gruel. Hot drink for invalids. 

Guaiacum. A drug used as an 
alterative. 

Gurgling. Sound of bubbling 
heard in a lung cavity by means of 
the stethoscope. 






GLOSSARY. 


39 7 


Gutta. A drop or minim. 

Gynecologist. A physician who 
is a specialist in the treatment of dis¬ 
eases peculiar to women. 

Gynecology. The study of the 
diseases special to women. 

H. 

Habit. That condition or quality 
one naturally possesses or acquires. 

Hair. The hirsute appendage of 
the skin. Each hair consists of a 
bulb and a shaft. 

Hair-follicle. Little pit in the 
skin in which the root of the hair is 
fixed. 

Hallucinations. Imaginary ap¬ 
pearances, the fault of disease of the 
brain. 

Hamamelis. Witch-hazel, pre¬ 
scribed for piles, diarrhea, and bleed¬ 
ing from various parts. 

Harelip. A congenital slit in the 
upper lip, sometimes double, and 
then consisting of two slits. The 
child is generally operated on very 
young, and the slit strapped up by 
specially cut strapping. It is most 
necessary to prevent the child crying, 
and to feed it with great care, or the 
slit may open again. Hare-lip is fre¬ 
quently associated with cleft palate 
(which see). 

Hartshorn. Ammonia; ordinary 
smelling-salts is a carbonate of am¬ 
monia, and in that form is generally 
called “ hartshorn.” Poison. 

Haversian Canals. The minute 
canals which permeate bone. 

Hay Fever. Attacks of parox¬ 
ysmal sneezing supposed to be caused 
by the pollen of plants irritating the 
nose; it occurs late in the summer. 
Inhalations of iodids and antiseptics 
is the usual local treatment. A 
respirator may be worn with advan¬ 
tage. Sea-bathing and tonics may be 
ordered. 

Headache. Pain in the head, 
especial in the frontal region. Sick 
and bilious headaches are due to dis¬ 
orders of the digestive system ; head¬ 
aches at the vertex , to cerebral 
troubles; and occipital headache to 
anemia. 

Healing. (See Union.) 


Heart. The muscular organ which 
pumps the blood through the system. 
The heart is situated behind the 
breast-bone in front of the chest with 
the apex, or small end, pointing 
rather to the left under the left 
breast. If the ear be placed over a 
healthy heart, a sound like that of 
gentle breathing is heard occurring 
with the rise of the heart; this is im¬ 
mediately followed by a short sharp 
sound as the heart falls back ; a short 
pause follows, then the first long 
sound again. A nurse should know 
the natural sounds, so as to recognize 
any deviation from them. In heart 
disease the patient generally turns 
blue, there is an anxious expression 
of the face, and the least exertion 
causes panting. All heart cases need 
the most incessant care and unbroken 
quiet, as the slightest movement or 
excitement may be fatal. 

Heartburn. Uneasiness and burn¬ 
ing in the stomach and cardiac region 
in indigestion; a gnawing sensa¬ 
tion. 

Heart-failure. Failure of the heart 
to act. 

Heat. Body-heat indicates a tem¬ 
perature of above 98.6° F. 

Hectic. The sudden feverish 
flushes of consumption and other 
protracted wasting diseases. The 
fever is not always present, usually 
coming on at night, when the patient 
is bathed in perspiration and is very 
weak. By careful changing of linen, 
gentle sponging, and arrangement of 
bed, much can be done by the nurse 
to ease the distress of the patient. 

Heel-bone. The largest bone of 
the foot, the calcaneum. 

Hellebore. A poisonous drug, 
used as a depressant. Antidote for 
overdose, stimulants. 

Hematemesis. Vomiting blood 
from the stomach. Dark-colored and 
often in clots. Recumbent position, 
ice to suck, notice the color of stools. 

Hematin. The coloring matter of 
the red blood-corpuscles. 

Hematocele. A tumor containing 
extravasated blood. 

Hematoma. A blood-tumor. 

Hematosalpinx. Distention of 
the Fallopian tube with blood. 





39 8 


APPENDIX. 


Hematoxylon. Logwood ; a dis¬ 
infectant, chiefly used for sores. 

Hematuria. Blood in the urine ; 
may be a sign of malignant disease 
of the kidney. Urine looks smoky or 
claret-colored. Rest; ice-bags to the 
back. Astringents will probably be 
given internally. 

Hemicrania. Headache on one 
side of the head only. 

Hemiplegia. Paralysis of one side 
of the body. Watch for constipa¬ 
tion. 

Hemispheres. The two sides of 
the brain. 

Hemoglobin. Principal constitu¬ 
ent of red blood-corpuscles. 

Hemoptysis. Coughing up blood 
from the lungs. Frothy, and of a 
bright red color. Rest, no talking, 
ice to suck. All food must be cold, 
no stimulants. Watch the tempera¬ 
ture and pulse. 

Hemorrhage. A flow of blood. 

Hemorrhoids. Piles, small tumors 
about the anus. Usually the result 
of constipation or pregnancy. Regu¬ 
larity of the bowels must be secured. 
Bleeding piles may necessitate injec¬ 
tions of iced water or mild astrin¬ 
gents. 

Hemostatic. An agent to arrest 
a flow of blood. 

Hepatic. Relating to the liver. 

Hepatica. Medicines acting on 
the liver. 

Hepatitis. Inflammation of the 
liver. 

Hereditary. Transmitted from 
one’s parents. 

Hermaphrodite. One whose gen¬ 
erative organs are neither entirely 
male nor female. 

Hernia. Commonly called •' rup¬ 
ture;'’ protrusion of any of the inter¬ 
nal organs through the surrounding 
tissues, most common in the case of 
the bowels. Inguinal hernia is 
through both abdominal rings; direct 
through the external ring, and 
oblique through the internal ring. 
Strangulated , so tightly constricted 
that gangrene results if operation 
does not relieve. Scrotal is descend¬ 
ing into the scrotum, and umbilical is 
hernia at the navel. Taxis is the 
usual means of returning the pro¬ 


truded part if possible, and a truss is 
then worn to prevent the rupture oc¬ 
curring again. A rupture not amen¬ 
able to taxis is termed irreducible. 

Herniotomy. Dividing the con¬ 
stricting band of a strangulated 
hernia and returning the protruding 
part. The patient, after the opera¬ 
tion, must be kept recumbent; no 
food must be given save the light diet 
ordered. 

Heroic. Severe treatment of the 
kill-or-cure type. 

Herpes. Acute inflammation of 
the skin, with eruption. Herpes zoster 
shows in rings of vesicles around the 
body, and is usually called “ shin¬ 
gles”; circinatus, chiefly about the 
head, is called “ring-worm.” Local 
treatment consists of protection from 
irritation, a dusting-powder, or a 
mild astringent lotion. 

Hiccough. A short, noisy, invol¬ 
untary inspiration, caused by a spas¬ 
modic contraction of the diaphragm 
followed by a sudden closure of the 
glottis. A grave symptom when occur¬ 
ring in a serious case of illness. 

Hip-joint Disease. Inflammation 
of the hip-joint, most common in 
children, and extremely painful. The 
child is usually put in splints, and 
extension applied to prevent the 
painful jerking of the inflamed joint. 
The nurse’s duty is to avoid any jar¬ 
ring or movement of the patient, 
to keep the bed fresh and sweet, and 
the general health good, and to be 
very careful in lifting the patient, and 
to move slowly and gently. Abscesses 
often accompany hip-joint disease. 

Hirsute. Hairy. 

Histology. Science of the minute 
tissues of the body. 

Homeopathy. Medicine worked 
on the system of like cures like. 
Started by Hahnemann. Homeo¬ 
pathic medicines are mostly given in 
infinitesimal doses. 

Hot-water Bag. A rubber bag in 
which hot water of any degree can 
be introduced for topical application. 
Hot-water bottle is substantially the 
same as the above, the difference 
being merely in shape. 

Humerus. The bone of the upper 
arm. 




GLOSSARY. 399 


Humor. Any fluid of the body 
other than the blood. 

Hydragogue. A medicine which 
helps the discharge of water from the 
system. 

Hydrargyria. A sort of eczema 
caused by taking mercury. 

Hydrarthrosis. Accumulation of 
fluid in a joint, most common in the 
knee; white swelling. 

Hydrastis. A drug procured from 
the plant of Golden Seal, and used as 
a stomachic tonic, and as a local ap¬ 
plication for sores and ulcers. 

Hydremia. Excess of water in 
the blood. 

Hydrocele. Watery tumor in the 
scrotum. In infants, acupuncture 
may be performed; in adults, the 
treatment is usually injection, with 
a stimulating fluid, or excision. 

Hydrocephalus. Water on the 
brain ; a disease, most common in 
children, that causes the head to 
swell to an enormous size. The vic¬ 
tim is usually idiotic. 

Hydrocyanic Acid. A local seda¬ 
tive, allays irritation. Also anti- 
spasmodic. Poison. (See Prussic 
Acid. 

Hydroma. Watery swelling of a 
limb; a watery tumor. 

Hydrometra. Accumulation of 
water in the womb. 

Hydropathic. Relating to cure 
by means of water; by baths; and 
by the absence of alcohol as a 
drink. 

Hydrophobia. Madness of an 
acute form, contracted by the bite 
of a rabid dog. Tranquillity is of 
the greatest importance, and the 
nurse may do much to secure this 
and allay the terrible fears of the 
patient. Keep the room dark and 
quiet. The saliva of a hydrophobic 
patient is supposed to be capable of 
conveying infection, so a nurse must 
be careful on this point. 

Hydrotherapeutics. The water- 
cure from a scientific standpoint. 

Hydrothorax. Fluid in the cavity 
of the chest. 

Hygiene. The science of the pre¬ 
servation of health by means of at¬ 
tention to sanitary surroundings and 
habits. 


Hymen. A fold of membrane at 
the entrance to the vagina. 

Hyoid. The name of a bone shaped 
like a V, at the root of the tongue. 

Hyoscyamus. Henbane, a poi¬ 
sonous antispasmodic and narcotic. 
Enlarges the pupil of the eye. Anti¬ 
dotes , emetic of sulphate of zinc, am¬ 
monia, and stimulants. 

Hyperemia. Excess of blood in 
a part. 

Hyperesthesia. Excess of feeling 
in a part. 

Hyperidrosis. Excess of per¬ 
spiration. 

Hyperinosis. Excess of fibrin in 
the blood. 

Hyperplasia. Excessive growth 
of tissue. 

Hyperpyrexia. Excess of fever, 
shown by a very high temperature. 
Cold baths (temperature 65°) or cold 
packs with ice-water are often used 
to reduce the temperature; quinin, 
salicylic acid, and other drugs are 
sometimes given to reduce the tem¬ 
perature. (See Pack.) 

Hypertrophy. Excessive growth 
of a part; it is called false when 
caused by a deposit within the part 
and not by the general growth. 
Counter-irritants and stimulants, such 
as iodin, are sometimes applied lo¬ 
cally. 

Hypnone. A colorless, pungent 
fluid, used rarely as a soporific. 

Hypnotic. Agent for causing sleep. 

Hypnotism. State of unconscious¬ 
ness caused by straining the eyes to 
look at some bright object; a form 
of mesmerism. 

Hypochondriasis. Slight melan¬ 
cholia. The chief symptom is mental 
distress about the health, and delu¬ 
sions that the patient is the victim of 
many diseases. The attention should 
be distracted as much as possible. 

Hypodermatic. Under the skin ; 
a term applied to injections given 
under the skin by means of a hypo¬ 
dermic syringe. The injection is 
usually given in the fleshy part of 
the chest, thigh, abdomen, or arm. 
This syringe is marked in minims 
or drops, and fitted with a fine 
hollow needle. In giving an injec¬ 
tion pinch up a piece of the skin with 



400 


APPENDIX. 


the left hand; hold the syringe be¬ 
tween the thumb and middle finger 
of the right hand, with the first finger 
on the piston. Run the needle into 
and under the piece of pinched-up 
skin ; slowly and steadily press down 
the piston ; withdraw the needle 
gently and press a finger on the 
puncture for a moment to prevent 
the return of the fluid. The syringe 
must be kept perfectly clean ; a bristle 
kept in the needle will keep it from 
getting clogged with dust, etc. All 
drugs used as hypodermatics are 
highly concentrated, and many of 
them, such as morphia, atropia, etc., 
are poisonous. One-fourth of a grain 
of morphia is the hypodermatic most 
commonly ordered. 

Hypogastric. Term applied to 
the region of the abdomen just be¬ 
low the umbilicus. 

Hypoglossal. The controlling 
nerve of the tongue, situated under 
it toward the back. 

Hysteralgia. Pain in the womb. 

Hysterectomy. Complete or par¬ 
tial removal of the womb, either 
through the abdomen or the vagina. 

Hysteria. A nervous disease 
marked by convulsive seizures, and 
very often by dislike to food, painful 
impressions, and untruthfulness. The 
nursing of these cases is very trying, 
and can only be successfully carried 
on if the patient is removed from her 
usual surroundings, and her family 
kept at a distance. Infinite patience, 
and persistent cheerfulness mingled 
with a certain amount of sympathy, 
may work wonders. A good nurse 
will soon persuade a patient who has 
fasted for months to take food natu¬ 
rally again. Terrible weakness and 
even paralysis are brought on by 
hysteria. 

Hysterics. A term vulgarly ap¬ 
plied to screaming and crying fits in 
women, who cannot or will not con¬ 
trol their emotions. 

Hysterocele. Hernia of the womb. 

Hysteroscope. Mirror for reflect¬ 
ing light in examining a wound. 

Hysterotomy. Cesarean section, 
opening into the womb. The in¬ 
strument used is called a"hystero- 
tome.” 


I. 

Ice-bag. A bag of waterproof 
material filled with ice for applica¬ 
tion to any part of the body. 

Ichor. The thin colorless discharge 
from ulcers and other sores. 

Icterus. Jaundice : a yellow dis¬ 
coloration of the skin, caused by 
absorption of bile into the blood. 

Idiocy. Mental weakness, which 
dates from birth ; feeble-mindedness. 
Few know how much can be done 
with idiot children by patience. The 
kindergarten method of teaching 
them is admirable. Physical train¬ 
ing forms an important part of the 
treatment. A nurse who can secure 
the touching devotion of an idiot 
child will be able to cure him of all 
dirty habits, and even train his mental 
faculties to a varying degree. An 
idiot child should be placed in a 
home. 

Idiopathic. A morbid condition 
arising primarily, and not following 
on any disease or accident. 

Idiosyncrasy. An individual pe¬ 
culiarity in regard to the action of 
certain drugs, their action and effect 
being entirely different to what is 
expected. 

Ileo-cecal Valve. Valve at the 
junction of the large and small in¬ 
testine. 

Ileum. The lower portion of the 
small intestine. 

Iliac Arteries. There are five 
iliac arteries: i. Circujnflex, arising 
from the external iliac ; 2. common, 
the continuation of the abdominal 
aorta, dividing into (3) the external, 
and (4) the internal iliac. The bifur¬ 
cation is about at the last lumbar 
vertebra. The external iliac becomes 
the femoral after passing under Pou- 
part’s ligament. The branches of 
the internal iliac supply nearly all the 
pelvic organs. 

Iliac Region. The region con¬ 
taining the cecum, vermiform appen¬ 
dix, and some coils of the small 
intestine. 

Ilium. The shaft of the haunch- 
bone. 

Illusion. A deceptive appear¬ 
ance. 




GLOSSARY. 


401 


Immunity. Exemption from dis- 1 
ease by vaccination or by some analo¬ 
gous procedure, or by previous ill¬ 
ness. 

Impaction. State of being wedged 
in. 

Impetigo. A skin rash of an 
acute kind, chiefly seen in weakly 
women and children. Nutritive diet, 
and locally zinc ointment, will proba¬ 
bly be ordered. 

Implicated. Applied to fevers 
when two attack a patient at the same 
time. 

Impregnation. Act of rendering 
pregnant. 

Improvise. To do or to perform 
anything on the spur of the moment 
for a special occasion; to contrive. 

Impulse of the Heart. Sensation 
of a stroke felt on placing the hand 
on the heart, occurring as the ventri- j 
cles contract. 

Inanition. Exhaustion from want 
of food. 

Incarcerated. Applied to a hernia 
which cannot be reduced. 

Incision. Act of cutting into with 
a sharp instrument. 

Incisors. The eight front teeth. 

Incompressible. A full pulse, the 
beat of which cannot be arrested by 
pressure. 

Incontinence. Inability to retain 
the evacuations of the bladder or of 
the bowels. Incontinence of urine is 
often a disease of childhood. Much 
depends on the patience and firmness 
of the nurse in training in good 
habits. (See Enuresis.) 

Incubation. The period between 
the time when a disease is contracted 
and the time when the illness be¬ 
gins. 

Incubator. A sort of glass-cov¬ 
ered box warmed by hot-water cans, 
in which premature infants, born at 
the sixth or seventh month, are kept. 
The child is swathed in cotton, and 
never taken out of the box except to 
change the diaper. Great care is 
necessary to keep the box at the 
ordered temperature. 

Incus. A small anvil-shaped bone 
of the inner ear. 

Indigestion. Failure of the di¬ 
gestive powers; generally accom- 

26 


panied by morbid appetite and mental 
irritation. 

Indolent. A term applied to a 
painless sore which is slow to heal. 

Induration. The process of hard¬ 
ening. 

Inertia. Sluggishness; applied to 
the womb when it will not contract. 

Infant. A new-born child; a male 
should weigh at birth 7^ lbs., a 
female 7 lbs.; it should increase 6 to 
7 ounces in weight weekly. 

Infection. The communication of 
a disease through the atmosphere. It 
is particularly the nurse's duty in in¬ 
fectious cases to prevent the spread 
of the disease to others by thorough 
disinfection. 

Inferior Vena Cava. The chief 
vein of the lower part of the trunk of 
the body. 

Infiltration. An effusion of fluid 
into the connective tissue. 

Inflammation. A diseased state 
marked by heat, redness, swelling, 
and fever; it passes on to congestion 
of the parts, and possibly to suppura¬ 
tion or mortification. Thus inflam¬ 
mation of the lungs may become 
congestion ; the congested parts may 
dry up and die, and cavities are 
formed,and phthisis may set in. The 
Greek term for inflammation is 
“ itis "; hence we get glossitis, inflam¬ 
mation of the tongue; peritonitis, 
inflammation of the peritoneum ; and 
so on. 

Inflation. Blown out or expanded 
by air or gas. 

Influenza. Epidemic catarrhal 
fever. 

Infundibulum. A term applied to 
several funnel-shaped organs of the 
body. 

Infusum. An infusion : prepared 
by pouring boiling water on a drug, 
letting it stand and then straining. 

Ingesta. Food taken into the 
body through the mouth. 

Inguinal. The region at the lowest 
part of the abdomen on either side 
of the symphysis pubis. 

Inhalation. Act of breathing in 
vapor or fumes into the mouth, a 
form of treatment frequently ordered 
in disorders of the throat or chest. 
The ordinary inhaler consists of a 









402 


APPENDIX. 


vessel fitted with a mouth-piece com¬ 
ing out of the lid ; the hot water and 
the medicament ordered are put in 
the vessel and the patient takes the 
mouth-piece in his mouth and in¬ 
spires the vapor which rises through 
it. A teapot makes a very good in¬ 
haler, the patient keeping the spout 
in his mouth. 

Inhibition. The arrest of some 
activity by the restraining influence 
of a nerve-centre. 

Injection. A watery or other so¬ 
lution thrown into the vessels beneath 
the skin, or into any cavity of the 
body. 

Innominate. Name of the large 
artery of the body proceeding from 
the aorta. 

Innominatum. The pelvic bone. 

Inoculation. The injecting of 
diseased fluid from the body of one 
creature into the body of another, as 
calf lymph is used to vaccinate chil¬ 
dren. 

Insanity. Madness ; disease of 
the brain causing loss of reason. The 
four principal types of the affection 
are melancholia, mania, delusional 
insanity, and dementia. (See Puer¬ 
peral mania.) The nurse must never 
argue with an insane patient ; she 
must watch and be patient ; no 
matter what violence she suffers, 
she must never strike the patient 
back again. In restraining a mad 
person, catch hold of the gar¬ 
ments, not the limbs. The nurse 
who knows no fear, never loses her 
self-control, and is ever watchful, 
stands in no danger from even the 
most violent patient. 

Insertion. The attachment of a 
muscle to the part it moves. 

Insomnia. Sleeplessness; often a 
troublesome complication during 
convalescence. 

Inspiration. Drawing in the 
breath. 

Instillation. Pouring in drop by 
drop. 

Instrument. Any mechanical de¬ 
vice or tool used in operation or 
treatment. Surgical instruments 
should be immersed in i : 40 carbolic 
solution ten minutes before the ope¬ 
ration; directly after the operation 


all hollow instruments should be 
taken to pieces, cleansed with a 
nail-brush, put together, and laid 
away in their cases. 

Insufflation. Blowing air into a 
cavity of the body. 

Insulation. State of a body sur¬ 
rounded by non-conductors of elec¬ 
tricity. 

Integument. The skin. 

Intestines. The alimentary canal 
from the stomach to the anus (see p. 
290). Intestinal obstruction arises 
from various causes, such as hard¬ 
ened feces. 

Intolerance. Constitutional in¬ 
capacity to endure or benefit by a 
remedial agent. 

Intoxication. The effect of the 
excessive use or an overdose of alco¬ 
holic liquor; in a wider sense, any 
poisoning. 

Intravenous. Denoting within or 
into the veins. An intravenous injec¬ 
tion is the introduction into the vein 
of a saline solution or other liquid. 

Intubation. Passing a tube down 
the throat and leaving it there; an 
operation sometimes performed on 
children with diphtheria instead of 
tracheotomy. It needs careful nurs¬ 
ing, for the tube may be coughed up 
or may be swallowed. 

Intussusception. The reception 
of one part of the intestine into an¬ 
other ; common in children and caus¬ 
ing obstruction of the bowels, and 
calling for prompt treatment. 

Inunction. Rubbing in of medi¬ 
cines with a view to effect absorption. 
Generally resorted to when the 
stomach will not tolerate the medi¬ 
cine. 

Invagination. Another term for 
intussusception. 

Inversio Uteri. Inversion of the 
womb, so that it is turned inside out, 
and generally falls into the vagina. 

Involuntary. A term applied to 
certain motions and functions of the 
various ’organs of the body that are 
not controlled by, or are not depend¬ 
ent on, the will. 

Involution. The shrinking of the 
womb after labor. The womb, from 
weighing a pound and a half at labor, 
shrinks in eight weeks to the weight 





GLOSSARY. 


403 


of an ounce and a half. Any chill 
may arrest this involution and cause 
great mischief. 

Iodin. A poisonous element ob¬ 
tained from the ashes of seaweed. 
Very useful as an antiseptic. The 
solution is painted on the skin to 
cause absorption. The tincture is 
given internally for scrofula, etc. Re¬ 
port at once any catarrhal symptoms. 

Iodoform. A form of iodin con¬ 
sisting of yellow crystals or a prim¬ 
rose-colored powder. It possesses a 
strong and lasting odor. It is largely 
used to dust on wounds, its action 
being antiseptic and stimulating. 
Iodoform gauze, w r ool, and lint are 
employed. The symptoms of poi¬ 
soning from iodoform are vomiting, 
hallucinations, red skin rash, and 
dusky urine. 

Iodol. Ointment containing iodin, 
and having the same properties as 
iodoform, without the strong smell. 

Ipecacuanha. A prompt emetic, 
secured from the root of a Brazilian 
plant. Greatly used for children in 
cases of croup and whooping-cough. 
In small doses it is a stomachic and 
expectorant; when used as an emetic, 
some 60 drops are given. 

Iris. The colored circle surround¬ 
ing the pupil of the eye. 

Iron. When ordered as a medi¬ 
cine, should be given after food and 
through a tube. Dialyzed iron does 
not injure teeth. Iron causes black 
stools. 

Irreducible. That which is inca¬ 
pable of being returned to its proper 
place by manipulation. 

Irrigation. Constant application 
of a lotion to a part. 

Irritant. A drug which causes 
excitation and stimulates action. 

Irritation. An inflamed state; 
also, the stimulus necessary to the 
performance of the functions of an 
organ. 

Ischium. The hip-bone ; the back 
part of the os innominatum. 

Isolation. Set apart; an isolation 
room or ward is one kept for con¬ 
tagious or infectious diseases, and the 
nurse has to follow strict rules to 
prevent the spread of the disease. 
A sheet hung over the door of such 


a room, and kept saturated with car¬ 
bolic or some other disinfectant, to 
prevent the disease germs that are in 
the air getting out at the door and 
into other parts of the building. 

Itch. A skin eruption. (See 
Scabies.) 

J. 

Jaborandi. A drug containing 
pilocarpin and jaborin. It increases 
perspiration and stimulates the heart. 

Jalap. A drug which purges rap¬ 
idly, acting in from two to four hours. 

jaundice. Disease of the liver 
causing yellowness of the skin ; usu¬ 
ally brought on by over-indulgence 
or by chill. Infants often become 
jaundiced, and should then be kept 
indoors, and an extra fold of flannel 
put round the body. In the diet of 
a patient, avoid fat and sugar as 
much as possible, and give no wine. 

Jejunum. The upper portion of 
the small intestine. 

Joint. Point of union of two 
bones. (See Articulation.) 

Jugular. Relating to the neck. 

K. 

Keloid. A connective-tissue 

growth of the skin. 

Kidneys. Two organs in the re¬ 
gion of the hollow of the back which 
secrete the urine. In all diseases of 
the kidneys, the nurse has to measure 
and test the urine. 

Kilogramme. One thousand 
grammes, equal to 2.2 pounds 
avoirdupois. 

Kino. An astringent. 

Knock-knee. The inward curving 
of the knee. 

Koumyss. Fermented mare’s milk; 
nutritive and easily digested. Given 
in cases of wasting. (See p. 327.) 

Kyphosis. Hump-back deformity 
(curvature) of the spine. 

L. 

Labial. Relating to the lips. 

Labia Majora. Two large folds 
at the mouth of the pudendum ; called 
also the “ labia pudendi majus.” 

Labia Minora. Two smaller folds 




404 


APPENDIX. 


within the majora; called also the 
“ nymphae.” 

Labor. The progress of the birth 
of a child. There are three stages, 
(i) The dilatation of the mouth of 
the womb. (2) The passage of the 
fetus through the canal and its birth. 
(3) From the birth of the child to the 
coming away of the placenta. Prema¬ 
ture labor is the birth of a child after 
the seventh month, but before full 
time. 

Labor-pains. The pains of, or 
the contraction of, the uterus during 
labor. False labor-pains are irregu¬ 
lar and short, resembling colic, and 
occur with a certain regularity. 

Labyrinth. The internal ear, con¬ 
sisting of a series of cavities. 

Lacerated. A lacerated wound is 
one with torn or irregular edges; not 
clean-cut. 

Lachrymal. Relating to the tears 
and the glands which secrete them. 
The lachrymal or nasal duct conveys 
the tears from the lachrymal sac into 
the inferior meatus of the nose. 

Lachrymation. Excess of tears. 

Lactagogue. Drug for inducing 
milk-secretion. 

Lactation. The process or period 
of sucking. 

Lacteais. The lymphatic vessels, 
which convey the chyle from the in¬ 
testinal canal. 

Lactiferous Ducts. The canals 
of the mammary gland. 

Lactose or Lactin. Sugar of milk. 

La Grippe. (See Influenza .) 

Lancet. Surgical knife, with point 
and two edges, sharp. 

Lancinating. An adjective ap¬ 
plied to sharp cutting pains. 

Lanugo. The downy growth or 
first hair of the fetus. 

Laparotomy. Cutting into the 
abdomen ; a serious operation in the 
removal of a tumor, etc. 

Laryngeal. Relating to the 
larynx. 

Laryngismus Stridulus. Spas¬ 
modic croup accompanied by a crow¬ 
ing noise ; most common in infants. 
(See Croup.) 

Laryngitis. Inflammation of the 
larynx, causing loss of voice. Com¬ 
mon in clergymen and public speak¬ 


ers. May be chronic or acute ; the 
latter is serious. 

Laryngoscope. A reflector used 
for examining the throat. 

Larynx. The upper part of the 
windpipe, from which the voice- 
sounds proceed. 

Lassitude. A state of exhaustion 
or weakness arising from causes other 
than fatigue. 

Latent. Not visible, lying hid for 
a time. 

Lateral. Relating to the side. 

Laudanum. Tincture of opium, 
poison. Given in a few drops it re¬ 
lieves pain and procures sleep; it 
also arrests diarrhea. Sprinkled on 
a poultice or fomentation it allays 
pain. For an overdose the antidotes 
are emetic, external stimulation, walk¬ 
ing patient about, artificial respiration. 

Laughing-gas. Nitrous-oxid gas, 
given particularly by dentists to se¬ 
cure short anesthesia. 

Laxative. A mild purgative. 

Lead. The acetate is given in small 
doses as an astringent. The lotion 
evaporates rapidly and is cooling. 
The iodid makes a soothing oint¬ 
ment. 

Lead-poisoning. Difficult cases 
to nurse, owing to the frequent severe 
colic. Baths and opium fomentations 
are part of the treatment the nurse 
may have to look after. The diet is 
light but nutritive, with plenty of 
lemonade. Note blue line on gums. 
Lead-poisoning is common among 
painters and other lead-workers. 

Leech. An aquatic worm used for 
the local abstraction of blood. 
Leeches should be kept in a cool 
place, in a glass jar filled with rain- or 
river-water. The top of the jar must 
carefully be covered with muslin. 
The water should be changed weekly. 
The part to which a leech is to be 
applied should be washed and moist¬ 
ened with cool water; put the leech 
in a small wine-glass or test-tube, and 
reverse it on the part. If it will not 
bite, moisten the skin with sugar and 
water, or scratch the skin gently till 
the blood comes. When the leech 
has sucked its fill it drops off; it 
should then be disposed of by put¬ 
ting it in a very strong solution of 



GL OSSARY. 405 


salt and water or dry salt, cover the 
vessel tightly and let the leech remain 
until dead. 

Leiter Apparatus. Coils or tubes 
of flexible metal designed for appli¬ 
cation about any part of the body. 
Cold water is passed through the 
tubes, thereby reducing the tempera¬ 
ture of the parts encased. 

Leprosy. A constitutional malig¬ 
nant disease, cutaneous in its earlier 
stages, but afterward involving both 
tissue and bone. 

Lesion. Any injury or morbid 
change in the function or texture of 
an organ. 

Lethargy. Unnaturally deep 
sleep ; not quite so decided as coma. 

Leucemia. Increase of white cor¬ 
puscles of the blood. 

Leucocytes. White corpuscles of 
the blood. 

Leucomaines. Certain alkaloids 
developed in living tissue. 

Leucorrhea. A whitish discharge 
from the vagina, commonly called 
the “whites”; a sign of weakness. 
Must be reported to the doctor. 

Levator. A muscle which lifts up 
a part. 

Lichen. A term for a group of 
skin diseases in which the striking 
feature is inflammatory papules. 

Licorice Powder. A preparation 
containing senna; a purge. 

Lieberkiihn’s Glands. Tubular 
glands of the small intestine. 

Ligament. A tough band of 
fibrous tissue connecting together the 
bones at the joints. 

Ligatures. Threads of silk, wire, 
catgut, etc., used to tie arteries or sew 
up parts. The nurse has to see that 
all ligatures are sterilized and count 
the number used. Catgut, the most 
common ligature, may be kept in a 
solution of carbolic (1 : 10) and cut 
into lengths of 11 inches when re¬ 
quired for use. 

Lime, Chlorid of. A deodorant 
powder. 

Lime-water. Used to dilute milk 
for infants, and generally to counter¬ 
act acidity. Mixed with equal parts 
of olive oil, it makes carron oil, a 
dressing for scalds and burns. 

Lingual. Relating to the tongue. 


Liniment. A liquid for external 
application. 

Lint. Loosely woven cotton ma¬ 
terial, having one side smooth and 
the other side rough. As a rule, 
the smooth side is applied next the 
skin. The name “ lint ” is also 
given to scraped or unravelled linen, 
though the proper term for this is 
“ charpie.” 

Liquor Amnii. The watery fluid 
in which the fetus floats. 

Liquores. Solutions of active 
substances in water. 

Liquor Sanguinis. Liquid portion 
of the blood. 

Listerism. Antiseptic surgery. 

Lithemia. An excess of lithic 
acid in the blood, producing gouty 
dyspepsia. 

Lithia. An alkali, given in gout,etc. 

Lithoscope. Instrument for ex- 
examing the bladder. 

Lithotomy. Operation of cutting 
into a bladder to remove a stone. 

Lithotrity. Operation of crushing 
a stone in the bladder. Nursing 
treatment similar to that in lithotomy, 
but the urine must be measured and 
strained, and all fragments of stone 
kept for the surgeon's inspection. 

Lithuria. Passing gravel with the 
urine. 

Litmus Paper. Used in testing : 
acid turns the blue paper red ; alkali 
turns the red paper blue. 

Litre. About 1 quart; or 33.81 
fluidounces. 

Liver. The organ which secretes 
the bile ; it is situated in the abdomi¬ 
nal cavity on the right side. A yellow 
tinge of the skin marks derangement 
of the liver; the nurse must be care¬ 
ful that her patient gets no chill. 

Lobe. Rounded division of an 
organ. 

Lobelia. A drug used as an anti- 
spasmodic, and also in enemata. May 
cause poisoning. 

Lochia. The discharge following 
confinement; it is for two days ah 
most pure blood, then turns reddish- 
gray, and becomes clear by the ninth 
day, and then ceases. 

Lock-jaw. (See Tetanus.) 

Locomotor Ataxy. Impaired gait 
in walking. 




40 6 


APPENDIX. 


Lordosis. Anterior curvature of 
the spine. 

Lotion. A solution for external 
use. Evaporating lotions are used 
to procure local coldness. Lead 
lotion or eau-de-Cologne and water 
are the commonest. 

Lubrication. Making smooth, 
oily, or slippery. 

Lumbago. A rheumatic affection 
of the loins ; painful but not serious. 
Cold must be avoided. Rubbing in 
of such liniments as turpentine and 
chloroform, or aconite, may fall to the 
nurse's share ; or galvanic currents or 
hot baths. 

Lumbar. The region of the loins, 
right and left of the umbilicus. 

Lunar Caustic. Nitrate of silver, 
used to cauterize wounds, or arrest 
the growth of proud flesh. 

Lungs. The two organs of respira¬ 
tion, situated in the right and left 
side of the cavity of the chest. For 
nursing treatment of congestion of 
the lungs see Pneumonia. 

Lupuli. Hops; the tincture is a 
sedative and stimulant. 

Lupus. A tuberculous disease of 
the skin, most common on the face 
in young people of a consumptive or 
scrofulous tendency. Nourishing 
diet. 

Luxation. (See Dislocation.') 

Lying-in. Pertaining to the state 
of childbirth ; parturition. 

Lymph. A colorless alkaline fluid 
found in the lymphatic vessels. 

Lymphadenitis. Inflammation of 
the lymphatic glands. Tonics and 
nourishing diet. 

Lymphatics. Small vessels per¬ 
vading the body, and containing 
lymph. 

Lysis. Gradual decline of a fever. 

M. 

Macrocephalous. Very large¬ 
headed. 

Macrocytes. Abnormally large 
corpuscles present in the blood in 
anemia. 

Magnesia. A laxative and ant¬ 
acid. The sulphate (Epsom salt) is a 
powerful purge. 

Malaria. Effluvia from marshy 


ground; the cause of intermittent 
and remittent fevers. 

Malignant. An adjective applied 
to very virulent and dangerous forms 
of disease which run a more rapid 
course than the milder forms. 

Malignant Pustule. Anthrax 
contracted from cattle, causing gan¬ 
grenous carbuncle. 

Malingering. Shamming sick¬ 
ness. 

Malleolus. The projections of the 
ankle-bone. 

Malleus. A little bone of the 
middle ear. 

Malpighian Bodies. Small capil¬ 
lary masses in the structure of the 
kidney. 

Malpresentation. Unusual pre¬ 
sentation of the fetus at birth ; for 
instance, feet first. 

Mammae. The breasts, or milk- 
supplying glands. 

Mammary. Relating to the 
breasts. 

Mammitis. Inflammation of the 
breasts, generally occurs during lac¬ 
tation, and points to improved diet. 

Mandibulum. The lower jaw. 

Manganese. A drug used in skin 
diseases, in diseases of the kidney, 
and also to induce menstruation; it 
is tonic in its action. 

Mania-a-potu. Drink madness; 
delirium tremens ( q. v.). 

Manikin. A small representation 
of the human body used for teaching 
purposes. 

Manipulation. Rubbing and 
working with the hands to procure 
some healing result. 

Marasmus. A wasting of the 
flesh; generally due to tubercular 
disease of the mesenteric gland. 

Massage. Scientific rubbing and 
manipulation of the body ; strength¬ 
ens the tissues and restores tone gen¬ 
erally, acting as mild and thorough 
exercise for the patient. All move¬ 
ments are from the extremities toward 
the heart, and consist of kneading, 
rolling, beating, and rubbing move¬ 
ments. Ejffleurage , tapotement , and 
petrissage (which see) are the terms 
used for the chief movements, though 
each school of massage has its own 
terms and methods. 



GLOSSARY. 


407 


Masseter. A strong facial muscle 
which moves the lower jaw. 

Masseur. A male practitioner of 
massage. 

Masseuse. A female practitioner 
of massage. 

Mastitis. Inflammation of the 
breast. 

Mastoid. Having the shape of the 
breast. Mastoid process , the pro¬ 
truding part of the temporal bone 
felt behind the ear. 

Materia Medica. The branch of 
medical science which deals with the 
character and use of drugs. 

Maxilla. The jaw-bone. Inferior 
maxillary is the bone of the low'er 
jaw. 

Measles. An eruptive fever com¬ 
mon in children. First stage of 
coryza is infectious; the rash appears 
on the third day, commencing on 
neck and face, and lasting three days. 
Keep the patient in bed and feed with 
light diet. Watch for bronchitis or 
inflammation of the eyes or ears. A 
cough is usual in measles. The 
period of infection is supposed to last 
a month. German measles is a milder 
disease, the rash appearing on the 
fourth day, the period of incubation 
being ten days. Convalescence is 
usually rapid and uninterrupted. 

Meatus. An opening into a pas¬ 
sage. Meatus urinarius , the orifice 
of the urethra. 

Meconium. A black, sticky sub¬ 
stance voided from the bowels of an 
infant during the first day or two of 
its life. 

Median. In the middle ; an imag¬ 
inary longitudinal line dividing the 
body down the centre ; mesial. 

Medulla Oblongata. The en¬ 
larged portion of the spinal cord 
where it enters the base of the brain 
at the back of the head. 

Medullary. Relating to the mar¬ 
row. 

Melancholia. Morbid depression, 
a form of insanity. Watch for con¬ 
stipation. 

Melena. A discharge of black 
blood from the bowels. 

Membrane. A thin expanding 
tissue lining the cavities of the body. 
False membrane is a growth caused 


by inflammation, as in diphtheria. 
Mucous membrane , the continuation 
of the skin which lines those internal 
cavities and organs exposed to or 
communicating with the air. 

Meninges. The membranes of the 
brain. 

Meningitis. Inflammation of the 
membranes ol the brain, a serious 
disease, often ending fatally. Pains 
in the head are the first symptom, the 
temperature rises, and delirium sets 
in. Ice-bags to the head, iodoform 
•applications, and menthol may be 
ordered. The nurse must take the 
temperature every four hours, and 
watch for signs of collapse. Keep 
the room darkened and absolutely 
quiet; feed assiduously. There will 
probably be delirium. 

Meningocele. Protrusion of the 
brain through the skull. 

Menopause. Change of life ; the 
cessation of the menses, occurring 
1 about the forty-fifth year, and gen¬ 
erally a somewhat critical period. 

Menorrhagia. Excessive flow of 
the menses; may be due to many 
causes. Rest, flat on the back, and 
hot vaginal douches are almost cer¬ 
tain to be left to the nurse to see 
carried out. 

Menorrhea. The menstrual flow. 

Menses. The menstrual flow. 

Menstruation. Monthly discharge 
from the vagina, common in healthy 
females between the ages of thirteen 
and forty-five. 

Menthol. A local anodyne, often 
applied as a plaster. 

Mercurialism. Heart affection 
and trembling, caused by long use 
of mercury. 

Mercury. An alterative and pur¬ 
gative given hypodermatically and 
internally in cases of syphilis and in 
skin diseases. It is a poison in large 
doses, and the antidotes are white of 
egg and milk and water. (See Mer- 
curialism.) 

Mesentery. A large portion of 
the peritoneum to which the small 
intestines are attached. 

Mesmerism. The control of one 
will over another ; the influence be¬ 
ing supposed to be obtained by 
making passes with the hands. 




408 


APPENDIX. 


Metabolic. Capable of being 
changed. 

Metacarpus. The five bones of 
the hand joining the fingers to the 
wrist. 

Metastasis. Shifting of a disease 
from one organ to another. . 

Metatarsus. The five bones of 
the foot between the ankle and the 
toes. 

Metritis. Inflammation of the 
womb. 

Metrorrhagia. Bleeding from the 
uterus, other than at the period. 

Miasm. A noxious emanation 
generating in marshy localities ; ma¬ 
laria. 

Microbes. Germs capable of 
rapid increase; disease-germs or 
bacteria. 

Micrococci. Practically the same 
as microbes. 

Micturition. The act of passing 
urine. 

Midriff. The diaphram or muscle 
which divides the chest from the ab¬ 
domen. 

Midwife. A woman trained to 
attend confinements, and fulfil all 
duties so long as the labor is a nat¬ 
ural one. 

Midwifery. Obstetrics ; the knowl¬ 
edge necessary to performing the 
duties of a midwife. 

Migraine. Headache usually 
known as "sick headache" coming 
on periodically. 

Miliaria. Prickly heat; an affec¬ 
tion due to sweat-secretion and want 
of action of the skin. Sometimes 
occurs after operations or fevers, and 
causes rise of temperature. 

Minim. The sixtieth part of a 
fluidrachm ; practically one drop. 

Miscarriage. Premature birth of 
an infant, before seventh month. 

Mitral Valve. The valve of the 
heart between the left auricle and the 
left ventricle. 

Modus Operandi. The method of 
operating. 

Molluscum. Skin disease, either 
contagiosum, common in childhood, 
or fibrosum , involving the tissue. 

Monoplegia. Paralysis of one limb 
only. 

Monster. A creature born of 


woman, but so malformed as to have 
but slight resemblance to a human 
being. 

Mons Veneris. The eminence just 
over the os pubis in women. 

Morbid. Unnatural, diseased. 

Moribund. In a dying state. 

Morning Sickness. The nausea 
of pregnant women, occurring chiefly 
in the early months of gestation. 

Morphin. A vegetable alkaloid 
used as a sedative or anodyne. In¬ 
jected under the skin, it causes the 
pain to decrease, and sleep is in¬ 
duced. An overdose causes death, 
chiefly by paralysis of the muscles of 
respiration. Stimulation, artificial 
respiration, and an emetic are the 
antidotes. 

Morphinism. Chronic poisoning 
from indulgence in morphin. 

Mortification. The death of a 
part, gangrene. Always serious : the 
nurse must pay great attention to 
cleanliness, and use disinfectants. 

Movements. The evacuations of 
the bowels, which it is the duty of 
the nurse to note on her nursing chart 
in every case, and call the attention 
of the doctor if they exceed 2 in the 
24 hours (except in children), or if 
the patient goes more than 24 hours 
without passing any. The nurse 
should also note if they are streaked 
with blood, contain mucus, or undi¬ 
gested food, or worms. The color 
should be noticed ; it is like pea-soup 
in typhoid, light in jaundice, green in 
mercurialism. 

Mucoid. Resembling mucus. 

Muco-purulent. Containing mu¬ 
cus mingled with pus. 

Mucus. A viscid fluid of the body 
secreted by the mucous membranes. 
Mucus in the urine shows as a heavy 
white sediment, clinging to the bottle 
when it is shaken. 

Multipara. A woman who has 
had more than one child. 

Mumps. Parotiditis. A highly- 
infectious swelling of the salivary 
glands. Keep the patient isolated in 
a warm room ; take the temperature 
night and morning; give light nutri¬ 
tive diet. 

Murmur. A sound of the heart or 
the lungs heard upon auscultation. 





GLOSSARY. 4O9 


Muscle. Strong tissue of the body 
capable of great contraction, and the 
means by which the limbs are 
moved. Sterno-clcido-mastoid muscle, 
a large muscle on each side of the 
neck; it depresses and rotates the 
head. Involuntary muscle, one not 
under control of the will. 

Mutter. To utter with imperfect 
articulation, or in a low murmuring 
tone. 

Mycoid. Resembling a fungus. 

Mydriatics. Drugs used to dilate 
the pupil of the eye. 

Myocarditis. Inflammation of the 
muscular tissue of the heart. Often 
follows acute rheumatism: chances 
of recovery small. 

Myopia. Short-sightedness. 

Myotics. Drugs which cause the 
pupil to contract. 

Myrrh. A stimulating and tonic 
concoction of vegetable origin. 

N. 

Naboth’s Glands. Small glandular 
bodies situated at the neck of the 
uterus. 

Naphthalin. An antiseptic and 
expectorant. Given for indiges¬ 
tion. 

Narcosis. A state of unconscious¬ 
ness produced by the use of nar¬ 
cotics. 

Narcotic. A medicine which in¬ 
duces sleep. 

Nares. The nostrils. 

Nasal. Relating to the nose. 

Nates. The buttocks. 

Nausea. A feeling of sickness, but 
without actual vomiting. 

Navel. The umbilicus, the point 
of connection of the cord. 

Necrosis. Death of a part; usually 
applied to bone. Where there is 
dead bone there is always a sore, and 
pieces of dead bone at times work 
out through the sore : they should 
always be kept for the doctor to 
see. 

Negative Pole. That connected 
with the least oxidizable plate of a 
galvanic battery. 

Nematoidea. Thread-worms. 

Neonatorum. Of the new-born. 

Neoplasm. A new growth. 


Neoplasty. Any operation which 
restores lost tissue. 

Nephritis. Inflammation of the 
kidney. Measure and test urine, and 
watch for renal casts, pus, etc. Put 
patient between blankets. 

Nephrotomy. Cutting into the 
kidney. 

Nerve. A bundle of fibres con¬ 
veying sensation and volition to and 
from the organs. Motor nerves are 
those nerves which, passing from a 
nerve-centre, convey an order of 
motion; the opposite of sensory 
nerves which, passing to a nerve- 
centre, convey a sensation to the 
brain. Optic nerve, the nerve of 
sight arising in the occipital lobe and 
distributed to the retina of the eye. 
Sympathetic nerve is a nerve beside 
the spine. Vaso-motor nerves are of 
two kinds, those which cause con¬ 
traction, and those which cause dila¬ 
tion, of vessels. 

Nervous. Connected with the 
nerves; applied to low fevers and 
similar affections. 

Nettle-rash. (See Urticaria.') 

Neuralgia. Pains of a nerve or 
nerves ; if of the sciatic nerve it is 
sciatica ; or tic-douloureux or hemi- 
crania if of the nerves of the Gee. Very 
often neuralgia of one part is a symp¬ 
tom of disease elsewhere, and, there¬ 
fore, neuralgia should always be 
watched and reported. 

Neurasthenia. Nervous exhaus¬ 
tion. No cases are more trying to a 
nurse than those where the nerves are 
disordered. The patient is weak and 
fanciful, and needs to be treated with 
sympathy, yet with firmness; the 
nurse must be cheerful but quiet, pa¬ 
tient and forbearing, yet strict in 
carrying out the doctor’s orders. 

Neuritis. Inflammation of a nerve. 

Neuroses. A class of diseases 
connected with the nervous system, 
but arising from no structural cause 
which can be detected. 

Neutral. Neither acid nor al¬ 
kaline. 

Nevus. A birth-mark, a congenital 
blemish of the skin, often curable if 
the attention of the physician is 
called to it in time. 

New-horn. A designation applied 




4io 


APPENDIX. 


to the child for a short period after 
its birth. 

Nicotinism. Illness caused by 
over-indulgence in tobacco. 

Nictitation. Involuntary winking 
of the eyelids. 

Nightingale. A bed-cloak made 
out of two yards of flannel (see 
P- 35 )- 

Nipple. The small eminence in 
the centre of each breast. 

Nipple-shields. Coverings of 
glass or india-rubber put on the 
nipples to protect them when they are 
sore. 

Nitrate of Silver. Lunar caustic; 
used in the form of a pencil to arrest 
bleeding from a leech-bite or other 
small wound by its styptic action. 
Also to check the growth of proud 
flesh. As an astringent lotion, half a 
grain to the ounce, it is used to bathe 
the eyes in cases of ophthalmia. Salt 
and water is the antidote in case of 
poisoning. 

Nitric Acid. A corrosive fluid 
used in testing for albumin, etc. 
Minute doses, prescribed for indi¬ 
gestion, should be given after food, 
through a tube. If allowed to fall on 
the finger, it burns the skin. The 
antidotes for poisoning are alkalies, 
white of egg, and milk. 

Nitrite of Amyl. Useful as an 
inhalation in angina pectoris, and in 
some cases of poisoning. 

Nitrogen. A colorless gas enter¬ 
ing largely into the composition of 
the air we breathe. 

Nitroglycerin. An oily liquid, 
highly explosive, used as a heart- 
stimulant, and for neuralgia, etc. 
Sometimes causes headache. Must 
never be taken near a light. Poison. 

Nitrous Oxid. Laughing gas ; an 
anesthetic used for short operations, 
especially by dentists. 

Nodule. A little knob. 

Noli-me-tangere. A name given 
to bad ulcers, especially if on the 
face, and of syphilitic or consumptive 
origin. In dressing them, the nurse 
must certainly be careful to “ touch 
them not,” and to use disinfectants. 

Non compos mentis. Not of sound 
mind. 

Normal. The ordinary and proper 


state. Thus the temperature of the 
body in health is 98.4°, and this is 
said to be normal. The normal respi¬ 
ration in an adult should be about 16 
a minute; the pulse about 70 a 
minute. 

Nostalgia. Home sickness, or 
longing for home, so strongly devel¬ 
oped as to cause serious bodily ill¬ 
ness. 

Nostril. One of the external ori¬ 
fices of the nose. 

Nostrum. A quack medicine, or 
one of which the ingredients are kept 
secret. 

Nullipara. A woman who has 
never had children. 

Nutrient Enemata. A substance 
that nourishes by rectal injection. 

Nux Vomica. A form of strychnin 
much used as a nerve tonic and in 
cases of gastric affection, and also in 
paralysis. In large doses it is poison¬ 
ous, and the antidotes are an emetic, 
tannin, chloroform or ether inhala¬ 
tion. 

Nymphse. Two folds of mucous 
membrane on either side of the 
vagina ; the lesser or inner lips wiiich 
protect the orifice of the vagina. 

0 . 

Oakum. The fibre obtained by 
picking old tarred rope into pieces. 
Used to some extent in surgical 
dressings. 

Oatmeal. The meal made from 

oats. 

Obesity. Excessive fatness. 

Obstetrician. One who practises 
obstetrics. 

Obstetrics. That part of medicine 
and nursing which is connected with 
midwifery, and with the operations 
and illness due to the bearing of 
children. 

Obstruction. Stoppage or block¬ 
ing up of a canal or opening of the 
body. 

Occipital. Relating to the back 
of the head. 

Occiput. The back of the head. 

Occlusion. Closure. 

Ocular. Relating to the eye. 

Oculist. An eye specialist. 

Odontalgia. Toothache. 




GLOSSARY. 


411 


Odontoid. Tooth-like. 

Official. Term applied to medi¬ 
cines which are in the “ Pharmaco¬ 
peia.” 

Ohm. Unit of resistance in gal¬ 
vanism. 

Oidium Lactis. A micro-organism 
found in milk, and supposed to cause 
thrush in children. 

Oiled Silk. Silk impregnated with 
boiled oil, semi-transparent, and 
waterproof; used in the antiseptic 
dressing of wounds. Prepared in 
rolls of about 5 yds. long, and in 
widths of 25, 29, and 32 inches. 

Ointment. A soft application 
having healing virtues, usually con¬ 
sisting of lard impregnated with some 
drug. Ointment should be spread on 
lint with a palette-knife, and applied 
next the sore. 

Oleaginous. Oily. 

Olecranon. The bone composing 
the point of the elbow. 

Olfactory. Relating to the sense 
of smell. 

Olive Oil. A teaspoonful is some¬ 
times given to children as an aperient. 
It is used to oil instruments, such as 
the nozzle of an enema syringe. 

Omentum. A fold of fat in front 
of the intestines. 

Onychia. Inflammation of the 
matrix of a nail. 

Oophorectomy. Removal of the 
ovaries. 

Oophoritis. Inflammation of the 
ovaries. 

Opacity. Want of transparency, 
cloudiness. 

Operation. An act, especially a 
surgical act upon the body. Ope¬ 
rating-table , the table on which a 
patient lies during a surgical opera¬ 
tion. 

Ophthalmia. Inflammation of the 
eye. Once contracted, the cure is 
chiefly in the hands of the nurse; 
for constant care is alone successful. 
Rags used about the eyes must be 
promptly burnt, and the nurse must 
wash her hands in disinfecting fluid, 
for ophthalmia is contagious. Gran¬ 
ular ophthalmia is a chronic form 
with granulation of the lids. 

Ophthalmia Neonatorum. Oph¬ 
thalmia of the new-born. 


Ophthalmoscope. A small instru¬ 
ment fitted with a magnifying glass, 
and used to examine the eye. 

Opiate. A drug which causes 
sleep. 

Opisthotonos. A spasm which 
arches the back ; seen in severe cases 
of tetanus. 

Opium. A preparation of poppy- 
juice, much used to induce sleep and 
to allay pain. It contracts the pupil. 
Children are specially susceptible to 
the influence of opium. In large 
doses it is a poison, the antidotes 
being external, stimulation, cold 
water to the face, an emetic. 

Optic. Relating to the sight. 

Orbit. The bony cavity which 
holds the eye. 

Organ. A part constructed to ex¬ 
ercise a special function. Organs of 
generation , those that are functional 
in reproduction ; the genitalia. Pel¬ 
vic organs, those situated in the pel¬ 
vis. Urinary organs, those concerned 
in the secretion and excretion of the 
urine—the kidneys, bladder, ureters, 
and urethra. 

Organic. Relating to the organs ; 
thus, organic disease of the heart 
means that the structure itself is af¬ 
fected ; whereas, if the evil is inor¬ 
ganic it may be the result of mischief 
elsewhere, causing functional de¬ 
rangement of the heart. 

Orthopedic. Relating to the cure 
of deformities in children. 

Orthopnea. Breathlessness, the 
patient needing always to maintain 
an upright position. 

Os. A bone; also the mouth, as 
of the uterus. 

Os Calcis. The bone of the heel. 

Os Externum. Entrance to the 
uterus. 

Os Internum. The inner orifice 
of the uterus. 

Os Uteri. The mouth of the 
womb. 

Osseous. Like bone. 

Ossification. Hardening into 
bone. 

Ostalgia. Pain in a bone. 

Osteitis. Inflammation of a bone. 

Osteomalacia. Softening of the 
bones. Test urine. A lengthy and 
fatal illness. 




412 


APPENDIX. 


Osteomyelitis. Inflammation of 
the soft tissue of bone. Apt to oc¬ 
cur after amputations and to end 
fatally. 

Osteotome. A surgical saw for 
sawing bones. 

Osteotomy. An operation on a 
bone ; generally breaking and reset¬ 
ting it, as is done in the case of bow¬ 
legs. An anesthetic is used ; the pa¬ 
tient has to be kept quiet, and is put 
in splints. 

Osteotrite. An instrument used 
for scraping bone. 

Otalgia. Ear-ache. 

Otitis. Inflammation of the mid¬ 
dle ear, marked by rolling of the head 
and severe pain. Hot poultices, or 
even leeches, may be ordered. 

Otorrhea. A purulent discharge 
from the ear. In all diseases of the 
middle ear there is fear of penetra¬ 
tion to brain and fatal termination. 

Ounce. In fluid measure about 
two tablespoonsful. 

Ovarian Tumor. The conversion 
of the ovary into a tumor, which 
may grow to a tremendous size, and 
may contain hair, teeth, or sebacous 
matter. 

Ovariotomy. Excision of an 
ovary ; a serious operation, the nurs¬ 
ing treatment of which is very im¬ 
portant. 

Ovaritis. Inflammation of an 
ovary, very painful, and likely to de¬ 
press the patient. 

Ovaries. Two small, oval bodies 
situated on either side of the uterus, 
the female organ in which ova are 
formed. 

Over-distention. The state of 
being excessively stretched, or di¬ 
lated. 

Oviduct. The Fallopian tube be¬ 
tween the ovary and the womb, con¬ 
veying the ova. 

Ovisac. Small vehicles found near 
the surface of the ovary. 

Ovum. The egg: the embryo from 
which the fetus grows. Plural, ova. 

Oxalic Acid. A poisonous acid 
obtained from wood sorrel; antidotes , 
chalk and magnesia. 

Oxygen. A colorless, odorless 
gas. Inhalations in heart and chest 
cases. Applied to ulcers and sores. 


P. 

Pack. Wrappings of wet fabric ap¬ 
plied to a patient. A cold pack consists 
in wrapping the patient in a sheet 
wrung out of cold water, then envel¬ 
oping him in a dry blanket and mack¬ 
intosh, and leaving him for thirty min¬ 
utes, or the prescribed time. An ice 
pack consists in wringing out towels 
in ice water and applying them to the 
patient, perpetually changing them as 
they get warm. This last is to lower 
the temperature, and the temperature 
should be taken every few minutes 
while it is in progress. Hot pack is 
sometimes used in dropsy cases, and 
is applied in the same manner as 
the cold pack. Of course the pa¬ 
tient's body-clothing is removed be¬ 
fore a pack is given; and care must 
be taken to avoid chill, particularly 
after the pack, when the patient must 
be carefully dried. Packing the va¬ 
gina consists in inserting in the 
vagina pads of antiseptic cotton held 
together by a cotton string. 

Pads. Little pledgets of cotton 
enclosed in antiseptic gauze, and used 
instead of sponges. 

Paget’s Disease. A bright raw 
patch on the nipple that after some 
time develops into a cancer. 

Pain. Bodily or mental suffering. 
Griping pain, a spasmodic pain in the 
bowels. (See also Bearing-down 
pains , and Labor-pains.') 

Palate. The roof of the mouth. 

Palliative. A medicine which re¬ 
lieves but does not cure. 

Palpation. Examination by the 
hand. 

Palpitation. Rapid throbbing of 
the heart. Should always be reported 
to the doctor. Keep the patient at 
rest during the attack. 

Palsy. The popular name for 
paralysis (which see). 

Panacea. A medicine which cures 
all diseases. 

Pancreas. A long, flat gland be¬ 
hind the stomach ; it supplies a juice 
which aids digestion to the duodenum. 

Pancreatin. The active principle 
of pancreatic juice. 

Papilla. A small eminence; gen¬ 
erally applied to the nipple. 




GLOSSARY. 


413 


Papula. A small, solid pimple. 

Paquelin’s Cautery. A galvano- 
cautery on the syringe and ball sys¬ 
tem, in which the heat is obtained by 
benzoline vapor driven over plat¬ 
inum. 

Paracentesis. Tapping for dropsy; 
performed on the abdomen, chest, 
etc., to discharge the fluid secreted. 
(See Aspiration.) 

Paraldehyd. A swift soporific, 
having a pungent taste. As it is of an 
oily, unpleasant nature, it is usually 
given in stimulant (brandy) in the 
proportion of 1 to 3. It taints the 
breath. Poison. Antidotes , friction, 
strong coffee. 

Paralysis. Loss of sensation and 
of the power of movement. The 
one great point for the nurse in 
these cases is to prevent bed-sores. 
Measures must be taken to keep the 
patient dry and clean. Paralysis 
usually arises from brain disease, 
from injury to the spine, or nerve 
disease ; it may be partial or com¬ 
plete. Infantile paralysis occurs in 
weakly children under four years : the 
legs being usually affected. It arises 
from injury to the marrow of the 
spine, due to heat, cold, or over¬ 
walking. The limbs get thin, and 
must be kept wrapped in thick wool, 
and be rubbed night and morning for 
a quarter of an hour, passing the hand 
up the limb. Douching with hot water 
or electricity may be ordered. Prevent 
bed-sores, and give nourishing food. 

Paralytic Stroke. A sudden com¬ 
plete attack of hemiplegia. 

Paraphimosis. Retraction of the 
prepuce behind the glans penis. 

Paraplegia. Paralysis of the lower 
half of the body, including the bladder 
and rectum, so that the nursing direc¬ 
tions given under Paralysis must be 
carefully heeded. 

Parasite. Any living thing which 
draws its nourishment from another 
living thing. 

Paregoric. Camphorated tincture 
of opium used to relieve pain. 

Parenchyma. The spongy part of 
an organ. 

Paresis. A slight form of paraly¬ 
sis. 

Parietal. The two bones which 


form the vault and sides of the cra¬ 
nium. 

Parietes. The sides of any cavity 
of the body. 

Paronychia. Whitlow ; inflamma¬ 
tion and abscess at the end of a 
finger near the nail. 

Parotid. Near the air; applied to 
a conglomerate gland under the ear. 

Parotitis. Mumps (which see). 

Paroxysm. Periodical increase of 
disease. 

Parturient. Child-bearing. 

Parturition. The act of bringing 
forth young. 

Patella. The knee-cap. 

Pathogenesis. The origin and 
progress of disease. 

Pathological. Relating to pathol¬ 
ogy ; morbid. 

Pathology. The study of dis¬ 
eases. 

Patulous. Open, wide. 

Peccant. Not healthy. 

Pectoral. Relating to the breast. 

Pedicle. The foot-stalk which 
forms the neck of a tumor. 

Pediculus. The louse, a parasite 
infesting the hair and skin. An oint¬ 
ment will be ordered. The head may 
have to be shaved. If the lice are on 
the body, see that all clothing is dis¬ 
infected. Great cleanliness neces¬ 
sary. 

Pellicle. A thin skin or mem¬ 
brane. 

Pelvic. Relating to the pelvis. 

Pelvimeter. An instrument for 
measuring the size of the pelvis. 

Pelvis. The bony basin composed 
of the hips and the lower bones of 
the spine, and holding the bowels, 
bladder, and organs of generation. 

Pemphigus. A skin disease which 
is marked by eruptions of large blis¬ 
ters. 

Pendulous. Hanging down. 

Peppermint. Carminative and 
stimulant. A household remedy for 
flatulence and stomach-ache. 

Pepsin. The ferment of gastric 
juice, which chiefly causes digestion 
of the food in the stomach. 

Peptonized Foods. Food which 
has been partially digested by arti¬ 
ficial means. 

Percussion. Striking upon the 



414 


APPENDIX. 


chest, the sound heard being helpful 
in diagnosis. Place one finger of the 
left hand flat on the part to be exam¬ 
ined, and strike sharply with the ends 
of the three fingers of the right hand, 
holding them at the same length. 
There is a certain degree of resonance 
in the sound emitted, but this is dulled 
when there is fluid in the lung, or the 
lung is solid. Only a practised ear 
can detect and learn from the degrees 
of resonance, but the fact of dulness 
can be detected by a nurse, and may 
be useful to her. Immediate percus¬ 
sion is that by putting the finger 
against the patient and striking it, 
without the intervention of the plex- 
imeter. 

Perforation. A hole in an organ 
caused by disease. 

Perforator. An obstetrical in¬ 
strument for opening the cranium of 
the fetus. 

Pericarditis. Inflammation of the 
outer coat of the heart; apt to follow 
in cases of acute rheumatism or 
typhoid. Perfect rest, light diet, in¬ 
creasing watchfulness to anticipate 
all the patient’s wants. The remedies 
ordered must be kept ready at hand. 
The patient will probably breathe 
better if propped up by plenty of 
pillows. On no account should the 
patient be permitted to make a sud¬ 
den movement. 

Pericardium. The outer mem¬ 
brane or sac which holds the 
heart. 

Perineorrhaphy. Operation for 
repairing a perineum ruptured during 
labor. 

Perineum. The space between 
the anus and the vagina. 

Periosteum. The membrane cov¬ 
ering a bone. 

Peripheral. Relating to the cir¬ 
cumference or outer surface. 

Peristaltic. The worm-like con¬ 
tractions and movements of the in¬ 
testines in forcing onward their con¬ 
tents. 

Peritoneum. The membrane or 
sac which holds the intestines and 
viscera generally. 

Peritonitis. Inflammation of the 
peritoneum. The symptoms are shal¬ 
low breathing, vomiting, pinched fea¬ 


tures, abdominal pain with knees 
drawn up, and rapid pulse. May 
follow any abdominal operation, 
therefore these symptoms must be 
watched for, and at once reported. 
Treatment differs with the doctor in 
charge. A cradle must be placed 
over abdomen. Collapse must be 
feared. In peritonitis with perfora¬ 
tion of the bowel, the operation of 
laparotomy may be performed. The 
convalescence is slow, and care is 
needed for a long time. Death may 
occur from exhaustion. 

Peroneal. Pertaining to the fibula. 
A branch of the posterior tibial 
artery. 

Peroxid. Oxid containing a large 
preponderance of oxygen, 

Peroxid of Hydrogen. A power¬ 
ful antiseptic and germicide ; used as 
a disinfectant in diphtheria, etc., and 
as an antispasmodic. 

Pertussis. Whooping-cough; a 
contagious spasmodic cough, com¬ 
mon in childhood. The first ten days 
the patient should be kept indoors; 
the disease runs its course in from 
two to three months. Watch for chest 
complications. 

Pessament. A massage move¬ 
ment up the spine; pick up the flesh, 
and roll it between the thumb and 
fingers. 

Pessary. An instrument worn in 
the vagina to prevent or remedy pro¬ 
lapse of the uterus; generally in the 
shape of a ring or a ball, and made 
of gutta-percha or vulcanite. 

Petechise. Small red spots on the 
skin. 

Petrissage. A massage move¬ 
ment, consisting in picking up and 
rolling the muscles between the 
thumb and fingers—it is slow and 
continuous. 

Petroleum. A mineral oil; anti¬ 
septic and expectorant. Used to ex¬ 
pel worms. 

Petrous. Stony; a term given to 
a hard part of the temporal bone. 

Peyer’s Patches. Small glands 
situated on the surface of the intes¬ 
tines. 

Phagedena. Ulcers or wounds, 
which spread rapidly and slough. 

Phagocytes. Free parasites of the 







GLOSSARY. 


415 


body; supposed to counteract the 
action of disease microbes. 

Phalanges. The small bones of the 
fingers and toes. 

Pharmacopeia. An authorized 
handbook of directions for com¬ 
pounding medicines. 

Pharmacy. The science of pre¬ 
paring and mixing medicines or 
drugs. 

Pharyngitis. Inflammation of the 
pharynx. 

Pharynx. The membranous sac 
at the back of the mouth and leading 
to the stomach. 

Phenacetin. An antipyretic in the 
form of a tasteless, reddish powder. 

Phlebitis. Inflammation of the 
veins, caused by the coagulation of 
the blood in the vein. 

Phlebotomy. Bleeding a patient 
by opening a vein in the arm. 

Phlegm. Thick expectoration 
coughed up in chest diseases. 

Phlegmasia Alba Dolens. Com¬ 
monly called “ milk-leg,” a form of 
phlebitis occurring sometimes after 
labor. The leg becomes swollen, 
white, and tense, and is very painful. 
Slightly raise the limb on a pillow, 
and arrange it so as to give as much 
ease as possible. The danger is of the 
clot moving and going to the heart 
and causing sudden death. The 
swelling usually begins to go down 
after the ninth day. Gentle friction 
after the eighth week may be used. 

Phlegmatic. Sluggish. 

Phonetic. Relating to the voice. 

Phosphate. A compound of phos¬ 
phoric acid and a base. Phosphates 
in urine-appear as a dense, white de¬ 
posit ; a few drops of nitric acid dis¬ 
solves them at once. 

Phosphorus. A non-metallic ele¬ 
ment, used as a tonic and stimulant. 
It must not be allowed to come in 
contact with water. Give after food. 

Phosphuria. Excess of phosphates 
in the urine. 

Photophobia. Dread of light, a 
symptom of inflammation of the eyes. 

Phthisis. Consumption ; tuber¬ 
cular disease of the lungs. The pa¬ 
tient must be weighed, the diet nour¬ 
ishing, chills avoided, temperature 
taken, and the sputa noted as to color 


and amount. The night-sweats are 
often a distressing symptom, leaving 
the patient weak and wretched, and 
necessitating much patience and care 
in providing warm, dry changes. In 
cases of pyrexia, the temperature 
must be taken during the attack. 
The patient should wear wool only ; 
see that the bed-clothes are light. 
Before washing or dressing the pa¬ 
tient, and immediately after, give 
some stimulating food. If hemor¬ 
rhage comes on, give ice to suck. 
Note if the urine is scanty. 

Physiology. The science which 
treats of living bodies, and the laws 
which govern them. 

Physostigmin. Another name for 
eserin, and an antiseptic much used 
in eye cases. 

Pia Mater. The fine membrane 
surrounding the brain and spinal 
cord. 

Piles. Enlarged veins about the 
rectum ; hemorrhoids. Bleeding piles 
cause discharge of blood ; blind piles 
do not. 

Pilocarpin. A drug which causes 
increased salivation and perspiration. 

Pipette. A small graduated tube 
for taking up liquids. 

Pityriasis. A scaly skin disease. 
The serious variety rubra is most 
common in men of middle age. Diet 
nourishing, no stimulants. Rosea, 
which is most common in children, 
is not so obstinate to cure. 

Placebo. Medicine given to please 
the patient, often only tincture of 
orange or bread pills. 

Placenta. The after-birth ; a cir¬ 
cular, flesh-like substance surround¬ 
ing the fetus, and expelled from the 
womb after the birth of the child. 

Placenta Prsevia. Presentation 
of the placenta before the fetus. In 
these cases hemorrhage must be 
feared. 

Plantar. Relating to the sole of 
the foot. 

Plasma. The liquid in which the 
corpuscles of the blood float. 

Plaster of Paris. Used for pre¬ 
paring bandages for slight fractures. 
Rub the dry powder into a crinoline 
muslin bandage and pass it through 
a basin of water as it is used. For 



4i 6 


APPENDIX. 


the ordinary bandage, mix the plaster 
of Paris with cold water into a cream 
(an assistant must stir the cream con¬ 
stantly or it will harden), place the 
bandage in plain water, and re-roll 
in the plaster of Paris. 

Plasters. Used for keeping 
wounds together, binding sores, and 
applying medicaments to different 
parts of the body. The spreading of 
plasters is sometimes left to the nurse. 
Take a piece of glazed muslin and 
stretch it on a board with drawing- 
pins, spread the plaster hot with the 
edge of a warm knife. To apply a 
surgical plaster cut it into convenient 
strips, and hold the wrong side against 
a tin filled with hot water; this is a 
cleaner method than dipping the 
plaster into hot water. In removing 
plasters, commence at the corners 
and work toward the centre: never 
pull away from the wound, or you 
may tear it open. The marks left 
by plasters can be removed with 
chloroform. 

Pledget. A small compress of 
lightly-rolled lint, 

Plethora. Fulness; an excess of 
blood. 

Pleura. The membranous bag 
which holds the lung and lines the 
cavities of the thorax. 

Pleurisy. Inflammation of the 
pleura. This, like all chest cases, 
needs careful nursing; it is often 
found in conjuction with pneumonia 
or phthisis. Temperature every 4 
hours; poultices will probably be 
ordered ; temperature of room 65° ; 
fever diet. The sputa must be 
watched. In cases of effusion, aspi¬ 
ration may be perfdrmed. Great care 
is necessary in convalescence, and 
woolen vests must be worn. 

Pleuro-pneumonia. Pleurisy com¬ 
bined with pneumonia. The term is 
usually applied to a certain cattle 
disease. 

Pleximeter. An ivory disc or 
other hard substance placed on the 
body to receive the stroke in mediate 
percussion (q. v.). 

Plexus. A network of vessels or 
nerves. 

Pneumogastric. Relating to the 
lungs and the stomach, and applied 


to certain nerves, etc., connecting 
these two parts. 

Pneumonia. Inflammation of the 

lungs. Single pneumonia means one 
lung only is affected; double pneu¬ 
monia, that both lungs are diseased. 
Nearly every physician has a differ¬ 
ent method of treating pneumonia, 
but the most common nursing treat¬ 
ment is to keep the patient in bed, in 
a room with temperature of 65°; 
jacket poultices every four hours; 
temperature every four hours; keep 
a steam kettle going; liquid stimu¬ 
lating food frequently. Some physi¬ 
cians, instead of stimulating diet, ap¬ 
ply hot jacket poultices. Others, 
again, instead of poultices, apply ice- 
bags or Leiter tubes. The sputa 
must be kept for the inspection of the 
doctor. The crisis usually comes 
about the end of the first week, if 
delayed beyond the ninth day the 
case is critical; the convalescence 
takes three weeks. Relapse is al¬ 
ways to be feared, and flannel vests 
must be worn. 

Pneumothorax. Air in the pleural 

cavity. Causes shock, which is 
usually met with stimulants and opi¬ 
ates. Light food frequently. Aspira¬ 
tion may have to be performed. 

Pock-marks. The pits left by the 
small-pox pustules. 

Podophyllum. A drug used as a 
purge and as an alterative. 

Poison. A substance capable of 
producing noxious and even fatal 
effects when absorbed by the system. 
For a classification of poisons and 
their antidotes see p. 208. 

Polarization. The tendency to a 
reverse current in the battery cell. 

Politzer Bag. An india-rubber bag 
with long tube and nozzle. Used in 
ear cases, etc. 

Polyclinic. A large general hos¬ 
pital. 

Polyemia. Excess of blood. 

Polyuria. Excessive flow of urine 
of low specific gravity, and con¬ 
sequent thirst of patient. Meas¬ 
ure urine. Nourishing food. Avoid 
chills and make the patient wear 
flannels. 

Popliteal. Behind the knee; a 
term given to a certain artery. The 





GLOSSARY. 417 


continuation of the femoral artery, 
etc. 

Pore. A small opening. 

Positive Pole. The pole of a gal¬ 
vanic battery, by which electricity 
flows out from the generator. 

Position. Posture or attitude of 
the body in obstetric, gynecologic, 
or surgical examination and opera¬ 
tion. The dorsal position is lying on 
the back; the knee-chest position is 
the patient on the knees ; Sims' posi¬ 
tion is the patient lying on left side. 
(See pp. 137-143-) 

Posthumous. After death ; a post¬ 
humous child is one born after the 
father’s death. 

Post-mortem. The opening and 
examining of a dead body. 

Post-partum. After labor. Post¬ 
partum hemorrhage is bleeding after 
the child is born. 

Posture. Should be noted by the 
nurse ; the knees are drawn up in ab¬ 
dominal pain; the body lies flat in 
fevers ; shoulders raised in chest and 
heart complaint; arms overhead in 
heart complaint; lying on affected 
side in pneumonia, on stomach in 
colic. Slipping off the pillows is a 
sign of exhaustion. 

Potassium. A useful alkali; the 
bicarbonate is given in indigestion 
and rheumatic gout: the bromid in 
nervous diseases, epilepsy, etc.; the 
iodid in aneurysm, scrofula, etc., and 
to check milk-secretion ; and the per¬ 
manganate is a favorite disinfect¬ 
ant. 

Pott’s Disease. (See Spinal 
Curvature.) 

Pott’s Fracture. Fracture of the 
fibula close above the ankle, some¬ 
times also with dislocation of the 
ankle. Usually set in plaster splint. 
Twelve weeks’ rest necessary. 

Poultices. One of the most im¬ 
portant items of nursing treatment 
(see p. 95). 

Poupart’s Ligament. A muscle 
of the abdomen, stretching between 
the ilium and the pubis. 

Precordial. The region in front 
of the heart. Precordial pain , spas¬ 
modic pain about the heart, not or¬ 
ganic. 

Predisposition. A state of body 

27 


rendering it specially liable to certain 
diseases. 

Pregnancy. The state of being 
with child. Usual period 280 days. 
Morning vomiting a marked symp¬ 
tom. Test urine monthly. Abdotni- 
nal pregnancy , fetation in the abdo¬ 
men (see also Extra-uterine ). For 
signs of pregnancy see p. 115. 

Premature. Occurring before the 
proper time. 

Presentation. Position of the 
fetus at birth. 

Preventive. A medicine or agent 
which prevents the taking of disease ; 
prophylactic. 

Primary. The early stage, or 
symptom, of disease. 

Primipara. A woman who has 
borne a child but once. 

Probang. A slender rod, some¬ 
times with sponge attached, used to 
remove foreign bodies from the esoph¬ 
agus. 

Probe. A slender rod, usually of 
silver, used for exploring wounds. 

Proctitis. Inflammation of the 
rectum. 

Prognathous. Forward promi¬ 
nence of the jaws. 

Prognosis. The art of foretelling 
the course of a disease. 

Prolapsus Ani. The falling of the 
membrane of the rectum through the 
anus. Not uncommon in children 
who are constipated, and therefore 
given to straining. Regulate the 
bowels, and when they are acting 
press the buttocks together. 

Prolapsus Uteri. The falling 
down of the uterus into the pelvic 
cavity. 

Promontory. A projection of the 
internal ear. 

Pronation. Downward turning of 
the palm of the hand. 

Prophylactic. A preventive of 

disease. 

Prostate. Heart-shaped gland at 
the neck of the male bladder. When 
enlarged, causes retention of urine. 

Prostration. Extreme exhaustion 
of nervous or muscular force; col¬ 
lapse. 

Protective. Thin green oil-silk 
put between the first and second lay¬ 
ers of gauze in an aseptic dressing. 







418 


APPENDIX. 


Protein. Protoplasm ; an artificial 
compound almost similar to white of 
egg. 

Proud Flesh. Too vigorous gran¬ 
ulation, growing up above the proper 
surface of the wound. May have to 
be touched with caustic. 

Prurigo. A skin disease marked 
by very irritable and lasting erup¬ 
tions. Tar, sulphur, and naphthol 
may be applied locally, or by means 
of vapor baths. 

Pruritus. Local skin irritation, 
generally of the genitals. Medicated 
baths and soothing ointments may be 
ordered. 

Prussic Acid. Violent poison 
found in bitter almonds, laurel- 
leaves, etc. Antidotes : alkalies, 
chlorine, cold water dashed on face 
and neck. (See Hydrocyanic Acid.) 

Psoas. Two muscles of the loin ; 
a psoas abscess is a chronic abscess of 
the loins. These abscesses are most 
wearisome cases to nurse, and need 
the greatest care to avoid sepsis. If 
the dressing is left to the nurse, she 
must be most particular in every de¬ 
tail. Nourishing diet, cod-liver oil. 
The abscess is usually lanced, a drain¬ 
age-tube inserted, and an antiseptic 
dressing applied. 

Psoriasis. A scaly skin disease 
of a chronic character. Medicated 
baths, ointments, and arsenic subcu¬ 
taneously, may be part of the treat¬ 
ment to be carried out by the nurse. 

Psychical. Relating to the mind. 

Ptomaines. Minute alkaloid bod¬ 
ies found in putrefying matter, and of 
a poisonous nature. 

Ptyalism. Excessive flow of sa¬ 
liva. Sometimes a symptom of mer- 
curialism. 

Puberty. The period of develop¬ 
ment of the generative faculties or 
when reproduction first becomes pos¬ 
sible. 

Pubes. The hair-covered region 
about the genitals. 

Puerperal. Related to child-bear¬ 
ing. 

Puerperal Fever. Septicemia; 
fever following labor, and due to 
contagion. Note the temperature 
and pulse every four hours. Be 
extremely careful to use antiseptics 


freely. The fever is usually acute, 
reaching a crisis in a few days; then 
if the temperature, pulse, and respi¬ 
ration decrease, recovery is possible. 
Death usually results from exhaus¬ 
tion. 

Puerperal Mania. Usually begins 
from 4th to 14th day after childbirth, 
with pain in head, restlessness and in¬ 
somnia. Never leave patient alone ; 
keep the child and the family away. 

Puerperium. The period from 
childbirth to the time when the uterus 
or womb has regained its normal size; 
about six weeks. 

Pulmonary. Relating to the lungs. 

Pulsatilla. A drug used particu¬ 
larly in cases of arrested menstruation. 

Pulsation. Beating of the heart, 
or of the blood in the arteries. 

Pulse. To feel pulsation, put the 
three middle fingers on the radial 
artery at the wrist, beneath the thumb. 
The pulse in health beats about 120 
to the minute in infants, 80 in chil¬ 
dren, 60 to 70 in maturity, and 50 in 
old age. An intermittent or irregular 
pu^se is a sign of exhaustion ; a full 
pulse is a sign of the early stage of 
fever; a thread-like pulse is a sign of 
want of blood, and is common after 
hemorrhage; a hard pulse is one 
which is not easily stopped by press¬ 
ing on it; a soft pulse is easily com¬ 
pressible (see p. 39). 

Pupil. The iris or centre of the 
eye. 

Purgative. A medicine for caus¬ 
ing evacuation of the bowels. Should 
be given on an empty stomach. 

Purpura. A serious skin disease 
marked by purple patches, caused by 
the escape of blood from the vessels 
into the skin. Complete rest in hor¬ 
izontal position, and nourishing diet. 

Purulent. Pus-like. 

Pus. Matter given off from an 
open sore. Laudable or healthy pus 
is cream colored, not offensive, and 
not very thick. Unhealthy pus is 
brownish, offensive, and clotted. If 
stringy, it is a sign of scrofula. Pus 
in the urine shows as a white sedi¬ 
ment, thick and ropy ; it gelatinizes 
when liquor potassse is added. 

Pustule. A pimple containing pus. 

Putrefaction. The rotting away 




GLOSSARY. 


419 


of animal matter. Decomposition 
advanced to an offensive stage. 

Pyelitis. Inflammation of the 
pelvis of the kidney. 

Pyemia. Blood-poisoning caused 
by pus in the blood, and marked by 
the presence of abscesses. It usually 
occurs about the second week after 
an injury or operation. Be very care¬ 
ful not to convey the contagion else¬ 
where. Diet nourishing. Take pre¬ 
caution against bed-sores. Use anti¬ 
septics freely. Note the temperature 
and pulse both morning and evening. 

Pylorus. The lower opening of 
the stomach into the intestines. 

Pyrexia. A state of fever, ill-de¬ 
fined. 

Pyuria. Pus in the urine. 

Q. 

Quarantine. A period of separa¬ 
tion of infected persons from others, 
necessary to prevent the spread of 
disease. 

Quartan. A fever rising and fall¬ 
ing in periods of four days. If quinin 
is given, note if it arrests the parox¬ 
ysms. 

Quickening. The first movements 
of the fetus in the womb, usually felt 
by the mother at the end of the fourth 
month. 

Quicklime. Unslaked lime. 

Quinin. A tonic procured from 
the bark of a tree. It has remark¬ 
able antiperiodic properties, and is 
particularly useful in intermittent 
fevers. It should be given before 
food. 

Quinsy. Inflammation and en¬ 
largement of the tonsils. (See Ton¬ 
sillitis.) 

Quotidian. A fever having a pe¬ 
riod of twenty-four hours. If quinin 
is given, note if it arrests the parox¬ 
ysms. 

R. 

Rabies. Madness in animals. 

Racemose. Glands having numer¬ 
ous branched tubes. 

Rachitis. Rickets; a constitu¬ 
tional disease of childhood, marked 
by curving of the spine or long bones, 
and enlargement of the joints. Light, 


air, good food, and soap and water are 
the best cures for rickets, but if the dis¬ 
ease is far advanced, splints may have 
to be applied, and raw-meat juice and 
cod-liver oil be given. Rickety chil¬ 
dren are specially liable to colds, and 
must be warmly yet lightly clad. 

Radial. Relating to the radius. 
Radial artery is the smaller of the 
two terminal branches of the bra¬ 
chial. Begins at the bend of the 
elbow and extends along the radial 
side of the forearm, passes around 
the outer side of the carpus, and for¬ 
ward to the palm. 

Radical. That which goes to the 
root; thus radical treatment aims at 
an absolute cure, not a palliation. 

Radius. The smaller bone of the 
forearm, from the elbow to the wrist. 

Rale. Slight rattling sound heard 
in the air-passages upon ausculta¬ 
tion. 

Rash. (See Eruption .) 

Reaction. The effect produced in 
response to treatment. 

Reagent. One substance used as 
a test for another. 

Reaumur. A temperature scale 
of 80 equal degrees, from freezing (o°) 
to boiling point. 

Recrudescence. Return of bad 
symptoms. 

Rectitis. Inflammation of the rec¬ 
tum. 

Rectocele. Prolapsus of the rec¬ 
tum through the vagina. 

Rectum. The lower end of the 
large intestine from the colon to the 
anus. 

Rectus. Straight; applied to cer¬ 
tain muscles. 

Recurrent. Returning again. 

Reducible. A term given to such 
hernias, dislocations, etc., as can be 
replaced. 

Reflex Action. Involuntary action 
caused by irritation of the nerve- 
centre. 

Regimen. A rule of diet. 

Regurgitation. A backward flow 
of blood through defective valves; an 
eructation. 

Relapse. A return of disease after 
convalescence has once begun. 

Relapsing Fever. A contagious 
fever due to starvation. Light nour- 








420 


APPENDIX. 


ishing diet given very frequently, 
fresh air, warmth, and cleanliness. 

Remittent. Returning at regular 
intervals; applied to agues and fevers. 

Renal. Relating to the kidney. 

Rennet. A nutritious whey. 

Repair. (See Healing.) 

Resistance. In electricity the 
non-conducting force of certain 
bodies to the current. 

Resorcin. Antiseptic and anti¬ 
pyretic used chiefly in dermatology. 
May cause poisoning. 

Resorption. The absorption of a 
fluid or substance previously depos¬ 
ited. 

Respiration. Breathing. In count¬ 
ing a patient’s respiration, hide the 
fact of what you are doing; for in¬ 
stance, when taking the pulse, note 
the respirations. They should be 
in infants 50 to the minute, in chil¬ 
dren 36, in adults 16 to 18. Note 
whether the breathing is shallow or 
from low down, whether it is regular 
or intermittent. Note in which po¬ 
sition the breathing is easiest, and if 
accompanied by any noise such as 
the crowing of croup, or the snoring 
due to enlarged tonsils. 

Respirator. An instrument worn 
over the mouth to prevent direct con¬ 
tact with cold air. 

Rest-cure. The mode of treat¬ 
ment of patients suffering from hys¬ 
teria and neurasthenia, namely: (1) 
rest, (2) isolation, (3) systematic feed¬ 
ing, (4) massage and electricity. 

Restless. Deprived of repose or 
sleep ; unable to sleep. 

Resuscitation. Reviving those 
who are apparently dead. The Mar¬ 
shall Hall method of restoring the 
apparently drowned is rolling the 
body over from the back to the side, 
and pressing the chest on the raised 
side. 

Retching. Ineffectual efforts to 
vomit. 

Retention. To hold back. In¬ 
ability to void urine. 

Retina. The inner membrane of 
the eye, upon which objects are re¬ 
flected ; it is formed by an expansion 
of the optic nerve. 

Retractor. An instrument used 
to keep the edges of a wound apart, 


or to keep back muscles during an 
amputation. 

Retroversion. A morbid, back¬ 
ward inclination, as of the womb. 

Rheophores. The current-bearers 
of a battery : they are placed directly 
on the organ or muscle to be galvan¬ 
ized. 

Rheum. Rhubarb: a favorite purge. 

Rheumatism. A diseased condi¬ 
tion of the blood ; if acute, it is com¬ 
monly called rheumatic fever ; but it 
may be chronic or muscular. There 
is always great pain, and the nurse 
must so arrange the bed-clothes that 
no weight rests on the affected limbs. 
Put the patient between blankets. 
The temperature should be taken 
every four hours. Fever diet. Keep 
the temperature of the room not 
higher than 6o°. The two chief causes 
of death in cases of acute rheumatism 
are heart complications and hyper¬ 
pyrexia. The patient must never be 
allowed to move suddenly, even dur¬ 
ing convalescence. Cold baths or 
cold packs will probably be ordered 
for hyperpyrexia. Test the urine for 
acid reaction (see p. 293). 

Rhinitis. Inflammation of the 
nose. 

Rhinoscope. Nasal speculum. 

Rhubarb. A favorite household 
medicine given as a purgative. 

Ribs. Long lateral bones enclos¬ 
ing the chest, seven pairs of true ribs 
which join the breast bone, and five 
pairs of false ribs. Floating ribs are 
the two lower pairs of ribs. 

Rickets. (See Rachitis.) 

Rigor. A sudden attack of shiv¬ 
ering, usually the herald of a dis¬ 
ease. A nurse should note how 
long the rigor lasts, what the temper¬ 
ature of the patient was during the 
attack, and the hour of its occur¬ 
rence. Rigors should be immediately 
reported to the sister in charge. 

Rigor Mortis. The stiffening of 
the body after death. Articulo mortis 
is the moment of death. 

Ringworm. A circular skin erup¬ 
tion ; contagious and very difficult to 
cure if occurring on the scalp. The 
hair should be shaved and a cap of 
oil-silk worn. The ointment ordered 
must be rubbed in daily after wash- 




GLOSSARY. 


421 


ing the places with soap and water, 
and the nurse must see that the pa¬ 
tient’s general health is maintained. 
A separate brush and comb and 
towel must be kept for the patient. 

Risus Sardonicus. A convulsive 
grin, symptomatic of lock-jaw. 

Rochelle Salt. An aperient con¬ 
taining potash and soda. 

Roseola. A rose-colored rash 
due to slight fever, and of no great 
importance, 

Rubefacients. Mild irritants which 
cause redness of the skin. 

Rubella. German measles. Keep 
the patient in bed three days, and in 
the house a week. 

Rubeola. Measles (which see). 

Rupture. Hernia (which see). 
Rupture of a blood-vessel means the 
bursting of the same. 

S. 

Sac. A small bag, such as a her¬ 
nial sac. 

Saccharin. A substitute for sugar, 
used in diabetic cases ; it is usually 
in the form of tabloids, two of which 
( l A gr. in each) will sweeten a cup of 
tea. 

Sacculated. Bagged, or pursed 
out. 

Sacrum. The lowest division of 
the back-bone, forming part of the 
pelvis. 

St. Anthony’s Fire. Erysipelas. 

St. Vitus’ Dance. Chorea. 

Salicylic Acid. An antiseptic and 
antipyretic. A favorite drug for allay¬ 
ing the joint-pains of acute rheuma¬ 
tism. Causes depression and singing 
in the ears. Steel instruments must 
not be put in this acid. 

Salicylic Wool. An antiseptic 
wool impregnated with the white 
crystals of the acid and a small 
quantity of glycerin. This wool must 
not be shaken, or the crystals fall out 
and cause sneezing. 

Saline. Containing salts. A com¬ 
pound of an acid and an alkali. 

Saliva. The watery fluid poured 
into the mouth by the salivary glands. 

Salivation. An excessive secre¬ 
tion of saliva. 

Salol. A white powder composed 


of salicylic and carbolic acids. Given 
internally in acute rheumatism, and 
also used locally as an antiseptic. 
Note any decrease of urine. 

Saltpeter. Nitrate of potassium : 
diuretic and sedative. 

Salt-solution. Sodium chlorid 
(common salt) dissolved in distilled 
water. In medicine it is employed to 
restore to the system the fluids lost 
by severe hemorrhage, etc. 

Salve. An ointment. 

Sanguineous. Relating to the 
blood. 

Santonin. A worm expeller. 
Usually given in cream. After a few 
doses the sight becomes disordered. 

Sapremia. Poisoning of puerperal 
women by retention of some decom¬ 
posing matter. The cause being re¬ 
moved, there is rapid recovery. 

Sarsaparilla. A mild laxative ob¬ 
tained from the root of a Central 
American vine. Given in strumous 
and skin cases. 

Sartorius. The long muscle of 
the thigh. 

Scab. An incrustation formed 
over a wound. 

Scabies. The itch ; a contagious 
skin disease due to a parasitic insect. 
A sulphur bath will probably be 
ordered (four ounces of sulphid of 
potassium to thirty gallons of water, 
in a porcelain bath), in which the pa¬ 
tient should be allowed to remain 
for twenty minutes. Disinfect (or 
burn) all the clothing. Vaselin will 
relieve the soreness caused by 
scratching. 

Scalds. Cover up the scalded 
part with the dressing ordered (lint 
soaked in carron oil probably), and 
expose the part to the air as little as 
possible. Guard against shock and 
exhaustion. 

Scalpel. A straight knife ; chiefly 
used in dissecting. 

Scapula. The shoulder-blade. 

Scarification. Small incisions for 
blood-letting; used instead of cup¬ 
ping. 

Scarificator. A small box-like 
instrument fitted with many little 
blades, and used to perform scarifica¬ 
tion. 

Scarlet Fever, Scarlatina; an 




422 


APPENDIX. 


infectious fever accompanied by 
redness of the skin, and most com¬ 
mon in children. Period of incuba¬ 
tion, four to eight days; rash on sec¬ 
ond day. The rash shows chiefly on 
the chest and back, and lasts about a 
week. Then the fever subsides. 
Desquamation lasts about five w eeks, 
and this is the infectious period. 
Keep the room cool and well venti¬ 
lated, and a sheet soaked in carbolic 
solution hung over the door. Isola¬ 
tion is absolutely necessary, as is also 
disinfection and fumigation. (See 
Fumigation.') 

Schizomycetes. A general term 
for all classes of bacteria. 

Schneiderian Membrane. The 

lining membrane of the top of the 
nose. 

Sciatica. Neuralgia of the sciatic 
nerve—the large nerve of the hip. 
A very painful disease. Such local 
treatment as the injection of morphia, 
atropia, or thein, or the application 
of blisters, or cupping, may be left to 
the nurse. Keep the patient warm. 

Scleroderma. A chronic disease 
of the skin causing hardness. Turk¬ 
ish baths and rubbing in of lanolin 
or other ointment. 

Scleroma. A hardening of the 
tissues. Scleroma neonatorum , infan¬ 
tile disease. Rare, very fatal. 

Scoliosis. Lateral curvature of 
the spine. 

Scorbutus. Scurvy; a skin dis¬ 
ease marked by dejection and anemia, 
and caused by want of vegetable 
food. Plenty of green vegetables 
and lemons needed in the diet. Do 
not let the patient sit up or make any 
sudden movement, or syncope may 
be the result. 

Scrofula. Constitutional debility, 
with a tendency to tuberculosis. 
Characterized by swelling and sup¬ 
puration of the glands of the neck. 
Fresh air, nourishing diet, cod-liver 
oil, and attention to the general 
health are necessary. The glands 
may have to be removed. 

Scruple. A weight equal to 20 
grs. troy. 

Scurvy. Scorbutus (which see). 

Sebaceous. Fatty ; secreting oily 
matter. 


Seborrhea. Excessive secretions 
of the sebaceous glands. 

Secondary Disease. A disease 
consequent on another disease gone 
before. 

Second Intention. The healing 
of a wound by means of granulation, 
or the grow ing of new skin. 

Secretion. Substance separated 
from the blood by a natural function 
of the body. 

Section. (See Cesarean.') 

Sedative. A soothing medicine, 

Seidlitz Powder. A popular aperi¬ 
ent in the form of two powders, 
which, when mixed, effervesce. 

Semicircular Canals. Three ca¬ 
nals of the internal ear. 

Senility. Decline of power after 
passing the climacteric. 

Senna. A disagreeable rapid aperi¬ 
ent, usually given as a black draught. 
The syrup of senna is best disguised 
if given in coffee. 

Sepsis. The condition of putre¬ 
faction. 

Septic. Anything that causes pu¬ 
trefaction. 

Septicemia. Septic matter in the 

blood; blood-poisoning. Use disin¬ 
fectants freely. 

Septum. The division between 
two cavities; such as septum ven- 
triculorum , which separates the right 
ventricle from the left. 

Sequelae. Morbid conditions re¬ 
maining after, and consequent on, 
some former illness. 

Serum. The fluid of the blood in 
which the corpuscles float. 

Shingles. (See Herpes.) 

Shiver. A tremor or shaking of 
the body; often concomitant with or 
symptomatic of fevers, especially 
those of an infectious nature. 

Shock. Sudden prostration due 
to painful impressions; a frequent 
cause of death after operations and 
accidents, especially after burns. It 
is best met by stimulants and 
warmth. 

Show. A popular name for the 
sanguineous mucous discharge from 
the vagina before labor. 

Sigmoid Flexure. The flexure of 
the descending colon, shaped like the 
letter S ; serves to remove the fecal 





GLOSSARY. 


matter from the body by muscles of 
its own and ends in the rectum. 

Silkworm Gut. The thread drawn 
from a silkworm killed when ready to 
spin the cocoon. 

Sinapism. A mustard plaster. 

Sinciput. The upper fore part of 
the head. 

Sinew. A tendon uniting a muscle 
to a bone. 

Sinus. A passage leading from an 
abscess, or some diseased part, to an 
external opening. 

Sitz-bath.. A hip-bath. (See p. 82.) 

Sling. A bandage suspended from 
the neck for the support of a wounded 
arm or hand. 

Slough. Dead matter thrown off 
by gangrene or ulcers. 

Small-pox. (See Variola.) 

Sneezing. Convulsive action of 
the respiratory muscles from irrita¬ 
tion of the mucous membrane lining 
the nasal cavity. 

Snoring. (See Stertor.) 

Snuffles. The peculiar hard 
breathing noise by infants affected 
with chronic cold in the head. 

Sodium. The basis of common 
salt. The bicarbonate is a favorite 
remedy for acidity of the stomach. 
The chlorid is an emetic. The sul¬ 
phate a cathartic. The nitrate , given 
in epilepsy, etc., may cause serious 
symptoms. Sodamint is a prepara¬ 
tion given for indigestion. 

Solubility. Capable of being 
dissolved. 

Solution. The product of a solid 
dissolved by a liquid. In therapeu¬ 
tics , the termination of a disease. 
Solution of continuity , the separation 
of united parts, or division of tissues, 
as from a wound. 

Somnambulism. Walking in the 
sleep. 

Sopor. An unnatural profound 
sleep. 

Soporific. An agent which in¬ 
duces sleep. 

Sordes. The secretions collected 
about the teeth and on the lips in 
fever. 

Souffle. Sound heard on auscul¬ 
tation. 

Sound. A probe-like instrument 
used for exploring. 


423 

Spasm. Sudden involuntary 
movement. 

Spatula. A flat, flexible, blunt 
knife, used for spreading ointments 
and poultices. Also, in a smaller form, 
used to press down the tongue when 
the throat has to be examined. Every 
nurse should carry a spatula. 

Specific. Applied to a medicine, 
it means infallible; applied to a dis¬ 
ease, it means of special character. 

Specific Gravity. The weight 
or density of a substance compared 
with some standard substance—usu¬ 
ally water in the case of liquids. 

Speculum. A polished instru¬ 
ment for examining the interior cavi¬ 
ties of the body. 

Sphincter. A circular muscle 
which contracts the orifice of any 
organ. 

Sphygmograph. An instrument 
affixed to the wrist, which moves 
with the beat of the pulse and regis¬ 
ters the rate and character of the 
beats. 

Spica. A spiral bandage done 
with a roller in a series of figure 
eights. Most used for the shoulder, 
groin, thumb, and great-toe. 

Spina Bifida. A congenital mal¬ 
formation of the spine, forming a 
kind of tumor. Found in infants, 
and often terminating fatally. Usual 
treatment is tapping and subsequent 
dressing of absorbent wool, rather 
tightly strapped on. Watch for con¬ 
vulsions, signs of brain mischief, or 
paralysis. 

Spinal Cord. The marrow of the 
spine. 

Spinal Curvature. Constitutional 
curving of the spine. When accom¬ 
panied by caries of the spine it is 
called Pott's disease. A Sayre's 
jacket of plaster of Paris, applied 
during suspension, will probably be 
used. Long cases, needing good 
food and prevention of sores and the 
recumbent position. 

Spine. The back-bone or verte¬ 
bral column. 

Spirometer. An instrument for 
measuring the capacity of the lungs. 

Spissated. Thickened. 

Spleen. An oval body to the left 
of the stomach. Forms and purifies 





424 


APPENDIX. 


the blood. Hemorrhage is peculiarly 
liable to occur after any operation on 
the spleen. Such operations are 
always serious, and need careful 
nursing. 

Splints. Stiff pieces of board or 
material used to secure rest to some 
injured part. The most common are 
wooden splints, but iron, tin, felt, 
gutta-percha, etc., are used. An an¬ 
gular splint has one part at right 
angles to the other, and is used for 
the arm, the elbow occupying the 
angle. An interrupted splint has the 
part just over the wound removed to 
facilitate the dressing. The nurse’s 
duty is to keep splints clean and pad 
them for use. The pads should be 
linen stuffed with antiseptic wool, 
made slightly larger than the splint; 
the padding must be even. The pad 
can either be sown on by cross 
threads on the wrong side of the 
splint, or fastened on by three bands 
of strapping going right round the 
splint. When necessary, the pads 
near a discharging wound should be 
covered with oil-silk. 

Sponge. A porous substance, 
varying in texture, derived from an 
aquatic organism of low order, and 
formerly much used in operations. 
Artificial sponges of absorbent wool 
enclosed in antiseptic gauze are now 
used extensively instead of the nat¬ 
ural sponge. 

Sporadic. A disease which is not 
epidemic, but occurs in one or two 
isolated cases in a district. 

Sprain. Severe strain of a joint 
without dislocation. Cold-water 
bandages is the favorite mode of 
treatment, but severe sprains some¬ 
times need splints, ice-bags, and all 
the time and trouble given a fracture. 

Sputum. Expectorated matter 
from the mouth. 

Squill. Drug used as an expector¬ 
ant and diuretic. Overdose poisons. 

Staff. A lithotomy instrument 
used to guide the knife. 

Stapedius. A muscle of the in¬ 
ternal ear. 

Stapes. A stirrup-like bone of the 
internal ear. 

Stasis. Defective circulation of 
the blood. 


Stenosis. Contraction of an or¬ 
gan. 

Stercoraceous. Resembling the 

feces. 

Sterile. Barren ; inability to have 
children. 

Sterilization. Rendered free from 
germs ; generally by boiling. 

Sternum. The breast-bone. 

Stertor. The rasping, rattling 
sound produced when the larynx and 
the air-passages are obstructed with 
mucus. 

Stertorous. The snoring sound 
of breathing heard in apoplexy, 
etc. 

Stethoscope. A tube used for 
listening to the sounds of the chest 
and heart; one end is placed against 
the patient’s chest, and the ear of 
the listener at the other end. The 
binaural stethoscope has two flexible 
ends to apply to the ears of the list¬ 
ener. 

Sthenic. Strong, active. 

Stigmata. Marks on the skin. 

Stillborn. Born after the seventh 
month, but without having made a 
complete breath. 

Stillingia. Drug used as a ca¬ 
thartic ; also in cases of syphilis. 

Stimulant. That which causes 
temporary increase of the vital en¬ 
ergy. 

Stomach-pump. An instrument 
used for emptying the stomach by the 
mouth : also to feed refractory pa¬ 
tients. 

Stomatitis. Inflammation of the 
mouth, and ulceration; most com¬ 
mon in infants. Attend to the diet, 
give a mild purgative; wash the 
mouth out frequently with a little 
borax. 

Stools. Discharge from the anus. 

(See Motions.') 

Strabismus. Squinting; divergent 
when the eye turns out; convergent 
when it turns in. 

Stramonium. A drug used as a 

sedative. Overdose poisons. 

Strangulated. A hernia which 
cannot be reduced by taxis, but needs 
operation. 

Strangulation. Choking; con¬ 
striction. 

Strangury. Painful passing of 




GLOSSARY .; 


425 


urine in drops. Hot sponge to part, 
hot baths, etc., may be ordered. 

Strawberry Tongue. Applied to 
a characteristic clear-red appearance 
of the tongue in scarlet fever after a 
thick white fur has disappeared. 

Stricture. Contraction. Usually 
applied to the urethra, and conse¬ 
quent inability to pass urine. 

Stridulous. A creaking sound in 
breathing. 

Stroma. The tissue which forms 
the foundation of an organ. 

Strophanthus. A poison, used in 
small doses as a heart-stimulant. 

Struma. Scrofula ; or a scrofulous 
swelling. 

Strychnin. A poison, used as a 
nerve and spinal stimulant. Anti¬ 
dotes : an emetic, strong tea, ether 
inhalation. 

Stump. The part ot a limb re¬ 
maining after an amputation. 

Stupe. A fomentation (seep. 94). 

Stupor. State of unconsciousness. 

Styptic. Agent to arrest bleed¬ 
ing ; astringent. 

Subclavian. Under the shoulder- 
blade. 

Subcutaneous. Under the skin. 

Subinvolution. A condition of 
imperfect restoration of the uterus to 
its original size after delivery in child¬ 
birth. 

Subluxation. Sprain and partial 
dislocation. 

Subnormal. Below the normal. 

Subsultus. Involuntary twitch¬ 
ing. 

Sudor. Perspiration. 

Sudorific. An agent causing per¬ 
spiration. 

Suffocation. Stoppage of respi¬ 
ration. Asphyxia. 

Suffusion. Fluid poured out of 
its natural organ into the surround¬ 
ing parts. 

Sugar. To test for sugar in urine 
boil together a drachm of urine and 
a drachm of picric acid, add half 
drachm of liquor potassae, reboil; if 
sugar be present the color will be in¬ 
tense deep red, nearly black. 

Suggilation. Livid spots on the 
body. 

Sulphonal. Crystalline tasteless 
substance, used as an hypnotic. Give 


2 hours before bed-time. Note any 
headache next day. 

Sulphur. Used as a laxative. The 
ointment is used for skin diseases, 
particularly scabies. 

Sulphuric Acid. Vitriol. A poi¬ 
son ; the antidotes are lime-water, 
potash-water, oil and milk. 

Sumbul. Antispasmodic and stim¬ 
ulant. Given chiefly for neuralgia 
and hysteria. 

Sunstroke. Brain mischief caused 
by heat. Symptoms: Headache, sick¬ 
ness, confusion of ideas, refusal of 
food. Put patient in darkened room, 
and keep quiet. Ice to head. 

Superfetation. Supposed concep¬ 
tion by a woman already pregnant. 

Supination. Turning the palm of 
the hand upward. 

Suppository. A solid medicine 
introduced into the rectum or vagina. 

Suppression. Failure of the kid¬ 
neys to secrete urine. 

Suppuration. Gathering of pus 
under the skin. 

Sutures. Silk, silver-thread, or 
catgut used to sew a wound or tie an 
artery (see p. 171). Also the union of 
flat bones by their margins. 

Swelling. Morbid enlargement of 
a part. 

Symphysis. Growing together of 
bones. Sytnpkysis pubis , the line of 
union of the two pubic bones. 

Symptom. A sign by which dis¬ 
eases are recognized. 

Syncope. Suspension of the heart’s 
action and consequent state of swoon. 
Stimulation, warmth, and artificial 
respiration may have to be tried. Put 
the patient flat on his back and open 
the windows. 

Synovial Fluid. The liquid se¬ 
creted in the ligaments that lubricates 
the joints. 

Synovitis. Inflammation of the 
synovial membrane of a joint. 

Syphilis. Venereal disease, spe¬ 
cific and contagious. There are three 
stages, the one marked by primary 
symptoms, the second a period of 
outbreak, and the third certain well- 
marked sequelae. In dressing all 
sores in these cases the nurse must 
be most careful to use forceps, and to 
burn soiled dressings. Infantile syph- 




426 


APPENDIX. 


ilis is inherited ; the infant looks old, 
head large. 

Syringe. An instrument for in¬ 
jecting fluids. 

Systole. The contraction of the 
heart in its beat. 

T. 

Tabes. Wasting; dorsalis, a dis¬ 
order of the spinal marrow, marked 
by loss of power over the voluntary 
muscles ; mesenteric , consumption of 
the bowels. 

Tactile. Relating to the touch. 

Talcum. Silicate of magnesia ; a 
white, unctuous powder. 

Talipes. Club-foot. Talipes val¬ 
gus, the foot turned outward ; varus, 
the foot turned inward; equinus, the 
heel lifted from the ground; calca¬ 
neus, heel projecting downward. 

Tampons. Plugs of antiseptic 
wool enclosed in gauze, and used for 
introducing into the vagina, etc. A 
string is usually attached to the plug 
to aid in its withdrawal. 

Tansy. A favorite household 
remedy derived from a common 
plant. Promotes menses, and is a 
diuretic. Poisonous. 

Tape-worm. Tenia (q.v.). 

Tapotement. A massage move¬ 
ment; the hand is lightly clinched 
and held hammer-like, used to beat 
the muscles with swift, short strokes. 
All beating movements are sometimes 
included under this term. 

Tapping. (See Aspiration.') 

Tar. A thick, black, resinous 
substance obtained from the wood 
of the pine or fir tree. 

Tarsus. The seven small bones 
across the instep. 

Tartar. Incrustation on the teeth 
if they are not kept clean. 

Tartar Emetic. Potassio-tartrate 
of antimony ; an emetic ; or in small 
doses a sedative. 

Taxis. Hand-manipulation for 
restoring a part to its natural posi¬ 
tion, such as reducing a hernia. 

Tears. The fluid secreted by the 
lachrymal gland. 

Teeth. The principal organs of 
mastication. There are four kinds 
of teeth— incisors, canine, bicuspids, 


and molars. The first set of teeth in 
childhood are called “ milk-teeth,” 
which are only temporary teeth. 
They number 20, 10 in each jaw. 
namely, 4 incisors, 2 canine, and 4 
molars. The two middle teeth of 
the lower jaw should appear about 
the seventh month. In the adult the 
permanent teeth consist of 32 teeth, 
16 in each jaw, viz.: 4 incisors (front 
teeth); 2 canines; 4 bicuspids, and 6 
molars. (See Dentition.) 

Temperature. Degree of heat. 
The average temperature of the body 
in health is 98.2° F., but it rises 
slightly at night and falls in the 
early morning. A temperature of 
gg% 0 degrees indicates the presence 
of fever ; a temperature of 104° is 
serious. In collapse, the temperature 
falls below the normal point, and may 
be 96°. A subfebrile temperature 
is slightly feverish ; subnormal tem¬ 
perature is below the normal; an 
algid body-temperature is seen in 
pernicious intermittent fevers in 
which there is great coldness of the 
surface of the body. The tempera¬ 
ture of a sick-room should be 68° 
as a rule, rather lower for surgical 
cases, rather higher for chest cases. 

Temples. The part of the fore¬ 
head between the outer corner of 
each eye and the hair. 

Temporal. Two bones at the 
side of the skull containing the 
organs of hearing. 

Tenaculum. Small surgical hook 
to secure arteries, etc., and used by 
anatomists in dissection. 

Tendon. A sinew, a cord of fibrous 
white muscle. 

Tenesmus. Constant futile strain¬ 
ing to evacuate the bowels. 

Tenia. The tape-worm. When a 
cathartic has been given with the ob¬ 
ject of expelling this worm, it is the 
duty of the nurse to sift the evacuation 
through fine muslin, and see that the 
head of the worm comes away. If 
merely the long flat joints of the worm 
are expelled, the worm will grow 
again. 

Tenotomy. Cutting a tendon 
under the skin by means of a small 
knife especially devised for the pur¬ 
pose. As a rule no anesthetic is used. 




GLOSSARY. 


427 


Tension. Stretching. 

Tensor. A muscle which stretches. 

Tent. A prepared roll of lint or 
cylinder for keeping open a passage. 

Terebene. A preparation of oil 
of turpentine. From 5 to 10 drops 
on a lump of sugar acts as an ex¬ 
pectorant. A teaspoonful to a pint 
of water for an inhalation. 

Terminals. The extremities of a 
conductor of a battery. 

Tertian. An intermittent fever 
with attacks every third day. 

Testicles. The two glands of the 
scrotum, which secrete the semen. 

Testing. Finding the constituents 
of the urine by means of chemicals. 
The common tests include acid or 
alkali reaction, deposits of urates, 
phosphates or oxalate of lime ; pus, 
blood, chlorids, bile-pigment, albu¬ 
min and sugar. 

Tetanus. Lock-jaw. Severe 
spasms occur at intervals, during 
which try to prevent the patient 
biting the tongue, or in any way in¬ 
juring himself. Perfect quiet and 
darkness, as the least irritation re¬ 
news the spasms. Death may occur 
about the third or fifth day. Food 
and medicine can seldom be taken 
by the mouth in cases of tetanus. 

Therapeutics. That branch of 
medicine which treats of the appli¬ 
cation of remedies and all forms of 
cure. 

Thermometer. An instrument 
used to measure the degree of heat. 
There are several thermometric scales, 
the one in popular use in America 
being that of Fahrenheit. The ac¬ 
companying diagram presents to the 
eye the difference between the mark¬ 
ings of the centigrade and the Fah¬ 
renheit scales. Clinical thermometer 
is a slender glass instrument used to 
discover the temperature of the body. 
(See Temperature.') (See Fig. 7, p. 

43-) _ . , 

Thoracentesis. Puncture of the 

thorax, as the tapping for pleurisy. 

Thoracic. Pertaining to the chest 
or thorax. 

Thorax. The chest; the cavity 
which holds the heart and lungs. 

Thread-worm. Small parasitic 
worm in the rectum ; common only 


in children. Injections of salt water 
or quassia may be ordered. Oxyuris 
vermicu laris. 

Thrombosis. The consequent 
evils attending the presence of a 
thrombus, or coagulation of the blood, 
which, forming into a clot, obstructs 
some blood-vessel. 

Thrush. (See Aphtha’.) 

Thymol. An antiseptic, used as a 
solution or spray, also as an ointment. 

Thymus. A gland at the root of 
the neck. 

Thyroid. The name of the largest 
cartilage of the larynx, and of a gland 
in the front of the neck. 


Centigrade. 

Boiling-point 1 c _ C. 

of water, j WO 

9 ° ~ 
So — 
70 — 
60 — 

50 — 

40 — 
30 — 
20 — 

TO - 

Freezing-point ( o,_ 

of water. ) 


Fahrenheit. 
— ' 212 ° 

— 194 

—176 

-r58 

— T40 

—122 
—104 
— S6 
—68 
— 5 ° 


— TO 


— 20 


— T4 



-4 


Comparative thermometric scale. 


Tibia. The shin-bone ; the larger 
bone of the lower leg. 

Tibial. Pertaining to the tibia; 









428 


APPENDIX. 


the tibial arteries are the posterior and 
anterior, and pass from the knee to 
the ankle. 

Tic-douloureux. Neuralgia of 
the face, particularly about the 
temples. 

Tincture. An alcoholic solution 
of a drug. 

Tinnitus Aurium. A ringing in 
the ears. 

Tissue. The texture of a part. 
Areolar tissue is the filmy connective 
tissue of the body. Connective tissue, 
the white fibrous tissue which sur¬ 
rounds and connects the muscles, fat, 
etc., of the body. Elastic tissue, the 
yellow fibrous tissue of the elastic 
ligaments and membranes. 

Tolerance. Capacity to take a 
certain drug. 

Tongue-tie. Immobility of the 
tongue from a short frenum, the fold 
of mucous membrane in the middle 
of the under surface of the tongue. 

Tonic. A medicine which braces 
up the general health chiefly by in¬ 
creasing the appetite. 

Tonsillitis. Quinsy. Inflamma¬ 
tion of tonsils. Generally caused by 
cold or weakness. Difficulty in swal¬ 
lowing, hence give bread and milk and 
soft food. Swelling often disappears 
suddenly on fourth day, but it may 
go on to suppuration. 

Tonsils. Two oval bodies one on 
either side of the throat at the open¬ 
ing of the pharynx. When these 
glands are removed, rest from talking 
and eating, and ice to suck will be 
the nursing treatment. 

Torpor. Lethargy and want of 
feeling. 

Torsion. Twisting an artery to 
arrest bleeding. 

Torticollis. Wry-neck. Very often 
the least touch about the head in 
these cases will cause painful spasms, 
so the nurse must be careful. Rest 
and counter-irritation are usually 
tried, or, in obstinate cases, an opera¬ 
tion is performed, and the contracted 
nerve is stretched. 

Tourniquet. An instrument used 
to exert pressure on an artery and so 
arrest bleeding. 

Toxemia. A poisoned state of 
the blood. 


Toxic. Poisonous. 

Toxicology. Science of poisons. 

Trachea. The windpipe ; the air- 
passage from the larynx to the 
bronchi. 

Tracheotomy. The operation of 
making an opening into the wind¬ 
pipe, and inserting a tube so that the 
patient breathes through the tube 
instead of through the mouth. This 
is performed in cases, such as diph¬ 
theria, where the membrane is caus¬ 
ing suffocation; or scalded throat, 
where the swelling is closing the 
larynx. The nursing is most im¬ 
portant. The nurse must remem¬ 
ber that the tube must be kept 
clear, or death will result. Some¬ 
times a small piece of flannel wrung 
out in hot water and changed every 
few minutes is kept over the opening 
of the tube. 

Trance. State of unnatural sleep ; 
catalepsy. 

Transfusion. The transfer of the 
blood from one person into the blood¬ 
vessels of another, or the injection of 
a saline liquid. 

Trapezius. A large muscle be¬ 
tween the shoulders. 

Trauma. A wound or injury. 
Thus traumatic gangrene is gangrene 
arising from a wound. 

Tremor. Involuntary trembling. 

Trepan. A circular saw used for 
trephining. 

Trephining. Removing a circular 
piece of bone from the skull. 

Trichinosis. A disease caused by 
a spiral worm found in swine’s flesh, 
and called trichina. 

Tricuspid Valve. The right valve 
of the heart between the auricle and 
ventricle. 

Trismus. Lock-jaw. Trismus nas- 
centium, nine-day fits, a rare infantile 
disease, very fatal. (See Tetanus.') 

Trocar. The perforating instru¬ 
ment used to draw off fluids from 
the body. 

Trochanter. Two processes at the 
juncture of the neck and shaft of 
femur. 

Troche. A medicinal lozenge. 

Trunk. All the body except the 
head and limbs ; also the main stem 
of a nerve or vessel. 



GLOSSARY 


429 


Truss. A bandage or belt for re¬ 
taining a hernia in place. 

Tuberculosis. Disease caused by 
a bacillus to which there is, as a rule, 
an inherited tendency. Tubercle of 
the lungs is called “ phthisis.” It is 
connected with scrofula, and except 
in tubercular typhoid, it generally 
attacks one organ chiefly, and thus 
gives tubercular meningitis. 

Tumefaction. A swelling. 

Tumor. An enlargement due to 
a permanent morbid growth. Tumors 
may be simple or malignant; in the 
first case, they are not dangerous in 
themselves : in the second case, they 
are cancerous. They may also be 
solid or cystic. Phantom tumor is a 
false tumor of the abdomen, due to 
distention, peculiar to hysterical 
women. 

Turgescence. Swelling caused by 
fulness of the blood-vessels. 

Turpentine. Used in washing the 
skin, if it is necessary, to remove all 
grease. Also used to sprinkle on a 
fomentation where counter-irritation 
is required ; it must not be left on the 
patient too long. Styptic and anti¬ 
septic. Relieves flatulence and ex¬ 
pels worms. Give small dose on 
sugar, large dose suspended in yolk 
of egg. (See Terebene.) 

Tussis. A cough. 

Twitching. Irregular spasmodic 
contractions of the tendons. 

Tympanites. Wind-dropsy ; a dis¬ 
tended state of the abdomen caused 
by gas in the intestines or peritoneal 
cavity. 

Tympanum. Cavity of the middle 
ear, commonly called the “ drum.” 

Typhoid Fever. A continued 
fever, usually attended with ulcera¬ 
tion of the bowels and a rose-colored 
eruption on the abdomen appearing 
on the seventh day. The patient is 
kept flat in bed and not allowed to 
move ; liquid diet every two hours, 
day and night (any solid food may 
cause perforation of the bowels and 
death) ; the temperature taken night 
and morning, or for the first ten days 
every four hours. Take precautions 
against bed-sores. If ordered to 
sponge the patient, put a little toilet 
vinegar into the water; cold pack or 


baths may be ordered. The fever 
may last three weeks, and complica¬ 
tions often follow, so the symptoms 
must be watched for and reported. 
Typhoid is infectious through the 
excreta, and the nurse must be care¬ 
ful to keep a solution of carbolic acid 
in the bed-pan, and to well flush the 
drains and put down a liberal supply 
of disinfectant. All the patient’s 
body-linen and bed-clothing must be 
soaked in carbolic acid or boiling 
water before being sent to the wash¬ 
ing. 

Typhus Fever. A highly infec¬ 
tious fever. Cold bath or sponging 
may be ordered; temperature every 
four hours. Rash comes out on 
seventh day, crisis about twelfth day. 
Toward the crisis, heart-failure is pos¬ 
sible, and stimulants should be at 
hand. Keep the room well venti¬ 
lated ; liquid diet, and directly the 
crisis is past, fowls, fish, and chops 
may be given. The convalescence 
is rapid as a rule. The utmost 
care must be exercised to disinfect 
the patient, the room, and every¬ 
thing that has been in it. (See Fu¬ 
migation.) Burn as much of the pa¬ 
tient’s body-linen as possible. Watch 
for retention of the urine, or signs 
of lung mischief. The nurse must 
live well herself, and be careful of 
her health ; she must wear only 
washable dresses. 

U. 

Ulcer. A sore, attended by dis¬ 
charge. Ulcers are local when con¬ 
fined to one spot; constitutional when 
liable to appear on different parts of 
the body. They are usually dressed 
with stimulating lotions or powdered 
oxid of zinc, the dressing firmly band¬ 
aged on to support the part. 

Ulna. The larger bone of the fore¬ 
arm from the elbow to the wrist. . 

Ulnar. The name of an artery 
and a vein running beside the ulna. 
Ulnar artery is one of the two ter¬ 
minal branches of the brachial artery. 
Begins just below the bend of the 
elbow, passes to the ulnar side of the 
forearm, thence to the wrist, and 
crosses the palm. 






430 


APPENDIX ,; 


Umbilical Cord. The funis ; the 
cord connecting the fetus with the 
placenta. 

Umbilicus. The navel, the scar 
in the centre of the abdomen where 
the funis was attached. 

Unconscious. The state of being 
without sensibility. 

Unguentum. An ointment. 

Union. (See First and Second In¬ 
tention.') 

Uniparous. Bearing one at a 
birth. 

Urea. The chief solid constituent 
of urine. To test for an excess of 
urea, take two drachms of urine, 
concentrate by evaporation to one 
drachm, add equal parts of nitric 
acid, and, if there be an excess, the 
nitrate of urea will crystallize out in 
abundance. 

Uremia. Presence of urea in the 
blood; a symptom of Bright’s disease 
or other disease of the kidneys. Cup¬ 
ping or poulticing over the kidneys 
may be ordered. Measure and test 
urine. Watch for convulsions. 

Uremic Fit. Bears some resem¬ 
blance to an epileptic seizure, but 
there is no flexing of the thumbs, and 
the breath has an odor of chloroform. 
Prevent the patient from injuring him¬ 
self. 

Ureter. The canal between the 
kidney and the bladder, down which 
canal the urine passes. 

Uretbane. An odorless, agreeable 
hypnotic. It is the ethyl salt of car¬ 
bonic acid. 

Urethra. The canal through which 
the urine is discharged. 

Urethritis. Inflammation of the 
urethra. 

Uric Acid. Lithic acid ; its pres¬ 
ence in urine is discovered by its re¬ 
semblance in color to Cayenne pep¬ 
per. Liquor potassae dissolves this 
red deposit. 

Urine. The fluid secreted by the 
kidneys. The normal amount se¬ 
creted in the 24 hours varies from 30 
to 50 ounces in an adult, 10 to 15 in 
a child, 8 to xo in an infant. The 
normal color is pale amber and clear, 
the specific gravity is from 1.018 to 
1.025. The reaction should be slightly 
acid, save after meals, when it is 


slightly alkaline. There should be 
no appreciable sediment. The fol¬ 
lowing may be present in urine and 
discovered by chemical tests : sugar, 
albumin, bile-pigment, chlorids, 
blood, pus, urates, uric acid, phos¬ 
phates, and oxalate of lime. 

Urinometer. A small glass instru¬ 
ment with a graduated stem, used for 
measuring the specific gravity of 
urine. 

Urticaria. Nettle-rash ; a skin dis¬ 
ease with eruptions causing great ir¬ 
ritation, generally the result of eating 
some unwholesome food. A soothing 
lotion (lime-water and zinc), dabbed 
on with a sponge, or a hot bath if 
very severe will relieve the irritation. 

Uterine. Relating to the uterus. 

Utero-gestation. The period of 
pregnancy. 

Uterus. The womb ; a fleshy body 
in the pelvic cavity about 3 inches 
long, and shaped like a pear; here 
the ovum grows during the period of 
pregnancy and the womb enlarges to 
hold it. All operations involving the 
uterus are serious, and must be nursed 
by strict gynecologic rules, especially 
with regard to the use of antiseptics. 

Uvula. A small fleshy body hang¬ 
ing down at the back of the soft pal¬ 
ate. When too long it often irritates 
the throat and has to have a piece cut 
off. This is a simple operation in¬ 
volving no anesthetic, and merely re¬ 
quiring that the patient suck ice after¬ 
ward, and take only fluid food for a 
short time. 

V. 

Vaccination. Inoculation of cow- 
pox lymph into the arm as a protec¬ 
tion from small-pox. Infants should 
be vaccinated before they are three 
months old, unless they have a skin 
eruption or are in bad health. 

Vagina. The passage leading from 
the vulva to the uterus. 

Valerian. A nerve-sedative that 
increases the heart's action, and is 
often prescribed in nervous and 
hysterical complaints. 

Valgus. Bow-legged. 

Vapor. An inhalation. 

Varicella. Chicken-pox. 





GLOSSARY. 


43 1 


Varicocele. A swollen and dis¬ 
eased state of the veins of the scro¬ 
tum. 

Varicose. (See Vein.) 

Variola. Small-pox. An infec¬ 
tious fever marked by an eruption of 
red pimples on the third day, which, 
about the eighth day, begin to dry up, 
the scab subsequently falling off. In 
confluent small-pox the eruption all 
runs together, there is a high state of 
fever, and great danger; especially 
about the third and ninth days. Use 
rags and artificial sponges for wash¬ 
ing the patient, and burn them imme¬ 
diately ; if possible, also use old body- 
linen and burn it. All the bedding, 
the room, and all its contents must be 
thoroughly disinfected. (See Fumi¬ 
gation.) Varioloid , mild small-pox. 
Watch for ulceration of the mouth or 
nose, inflammation of the eyes, and 
symptoms of chest disease. The in¬ 
fection may last two months. 

Varus. Knock-knee. 

Vas. A vessel, or duct of the 
body. 

Vascular. Relating to vessels. 

Vascular System. The system of 
blood-vessels. 

Vaselin. A bland ointment pre¬ 
pared from petroleum, and useful for 
dressings, greasing suppositories, etc. 

Vaso-motor. Causing motion in 
the vessels; applied to the sympa¬ 
thetic nerves. 

Vein. A vessel carrying the blood 
from the extremities to the heart. 
Veins, non-pulsating vessels which 
convey blood toward the heart. Jug¬ 
ular veins, two large veins of the 
neck. Varicose veins, a swollen state 
of the veins due to lack of action of the 
valves. Common in the veins of the 
leg. An elastic stocking and rest on 
a sofa may do good. The danger is 
of the veins bursting, in which case 
pressure must be applied over the 
bleeding-point, and also rather nearer 
the extremity. 

Venesection. Bleeding; opening 
a vein to let out blood. Provide a 
measuring-glass, into which to receive 
the blood, and a compress and roller- 
bandage for the dressing. 

Venous. Relating to the veins. 

Ventilation. It is part of the 


nurse's duty to see that her ward 
or sick-room is properly ventilated. 
There are very few diseases in which 
it is not permissible to have the win¬ 
dow open for an inch at the top, 
taking care that the draft does not 
blow straight across the bed. Always 
have a small fire, except in very hot 
weather. 

Ventral. Relating to the belly. 

Ventricles. The two lower cham¬ 
bers of the heart are known as the 
right and left ventricles. 

Veratrum Viride. A drug ob¬ 
tained from the hellebore, and used 
as a depressant. It lessens the circu¬ 
lation. Overdose poisons. 

Vermicide. A drug used to expel 
worms. Also called vermifuge. 

Vermiform Appendix. A curved 
tube, closed at one end, and opening 
at the other into the cecum. 

Vernix Caseosa. Cheesy stuff 
covering the fetus. 

Verrucse. Warts. 

Vertebrae. The small substantial 
bones which form the back-bone, or 
vertebral column. There are 24 
vertebrae: 7 cervical (neck); 12 dor¬ 
sal (back); 5 lumbar (loin). 

Vertex. The crown of the head. 

Vertigo. Giddiness. Any move¬ 
ment or sense of movement, either 
in the individual himself or in ex¬ 
ternal objects, that involves a real 
or seeming defect in the equilibrum 
of the body and is associated with 
more or less disturbance of con¬ 
sciousness. This condition may be 
due to pathologic conditions of the 
ears, the eyes, the brain, the stomach, 
the blood, etc. 

Vesica. The bladder. 

Vesical. Relating to the bladder. 

Vesicant. A blistering fluid. 

Vesicle. A blister. 

Vessels. Canals by which fluid 
is conveyed from one part of the body 
to another. 

Vestibule. A small cavity of the 
ear; also the angle between the 
nymph®. 

Vicarious. When one organ per¬ 
forms the work of another. For in¬ 
stance, when bleeding of the nose 
takes place in suppressed menstru¬ 
ation. 








432 


APPENDIX : 


Villi. Fine soft hairs. 

Vinum. Wine. 

Virulent. Violent, malignant. 

Virus. Contagious matter capable 
of spreading disease if introduced 
into the system. 

Viscera. The contents of the 
body-cavities. 

Viscid. Sticky and thick. 

Vitreous Humor. The glass-like 
fluid in the eyeball, behind the lens. 

Vivisection. Scientific internal 
examination of a living animal. 

Volatile. That which evaporates 
quickly. 

Volt. A unit of electric force. 

Vomit. Involuntary ejection of 
the contents of the stomach through 
the mouth. 

Vulva. The external organs of 
generation of a female. 

Vulvitis. Inflammation of the 
vulva. 

W. 

Water-beds. (See p. 33.) 

Water-brash. Heartburn, with 
flow of bitter water to the mouth 
caused by indigestion. 

Watt. Unit of electrical energy. 

Weaning. The termination of 
suckling. 

Wen. A sebaceous cyst. 

Wharton’s Jelly. The gelatin¬ 
like connective tissue of the umbili¬ 
cal cord. 

Whisky. An alcoholic liquid dis¬ 
tilled from fermented grain ; a stimu¬ 
lant. 

Whitlow. Inflammation near a 
finger-nail, with suppuration. Bread 
poultice till it comes to a head, and 
then lance it. 

Whooping-cough. (See Pertussis.) 

Wine. The alcoholic fermented 
juice of the grape. Port wine, a 
heavy wine from Oporto, Portugal. 
Sherry , a brownish colored wine, 


comes from Spain; the so-called 
“ sherry ” wines seldom contain any 
wine, being an artificial product. 

Wolffian Bodies. Two fetal ab¬ 
dominal bodies, forerunners of the 
kidneys. 

Womb. The uterus. 

Wood-wool. An absorbent wool 
used for dressings. 

Wounds. A healthy wound, not 
uniting by first intention, should fill 
up from the bottom, the edges should 
not be red or unequal. An abscess 
wound should pucker and the centre 
sink (see p. 188). 

Y. 

Yellow Fever. An epidemic fever 
marked by a yellow state of the skin, 
black vomit, etc. The fever is in¬ 
fectious, but the nurse is no more 
liable to catch it than others not in 
attendance on the sick. The first 
feelings are of languor and dyspep¬ 
sia, followed by twenty-four hours 
of high fever; if, after these twenty- 
four hours, the fever declines, there 
are hopes of recovery. Death may 
result from violent convulsion or 
from exhaustion. A mustard plaster 
to the stomach, or hot mustard bath, 
allays the sickness and convulsions. 
Beef-tea decreases the exhaustion. 
Mild purgatives are good, and any 
treatment which produces perspira¬ 
tion. The recovery is slow, and food 
must be given in very small quanti¬ 
ties, and be very light. Deafness and 
blindness may result. 

Z. 

Zinc. The chlorid is used as a 
caustic and disinfectant, the sulphate 
as an emetic in cases of poisoning by 
atropin, opium, etc. The ointment 
is used for dressing sores, particularly 
burns and scalds. 



INDEX 


Abbreviations, 344 
Abdomen, the, 305, 369 

condition of the, symptomatic, 50 
pregnant, rate of enlargement, 116 
Abscess, 192, 369 

Abscesses, cause of, following hypo¬ 
dermatic injections, 78 
Absorption of medicines, rapidity of, 
70 

Accidents and emergencies, 17 2-212 
Acetic acid, antidotes, 209 
Acetophenone, 359 
Acids, administering, method of, 75 
Aconite, antidotes, 211 
Action of medicines, 71 
Affusion, 88 

After-birth, management of the, 128 
After-pains, 131 
Air, composition of, 289 
night, purity of, 38 
of the sick-room, 37 
Air-bed, 33 

Albumin, nitric-acid test for, 295 
Alcohol, phenylic, 346 
Alimentary canal, 290 
Ammonia, antidotes, 210 
use of, in fainting, 201 
Ammonium, antidotes, 210 
Amniotic fluid, 118 
Amputation-stump, hemorrhage from, 
treatment, 194 

Amputations, after-treatment in, 163 
Anatomy, descriptive, 296-309 
—bones of the body, 296 
—brain, cord, nerves, and 
organs of sense, 301 
—female organs of genera¬ 
tion, 308 

—heart, blood-vessels, lym¬ 
phatics, 300 


Anatomy:—muscles of the body, 299 
—respiratory, digestive, and 
urinary organs, 305 
—skin, 296 

Anesthesia, surgical, 152 
chloroform, 155 
ether, 152 

Angina pectoris, treatment, 244 
Animals, rabid, bites of, 212 
Antidote defined, 208 
Antidotes. (See Poisons.) 
Antisepsis and asepsis, 167 
Antiseptic douche, surgical, 65 
(See Douches.) 
poultices, 100 
Antiseptics 168-171, 341 

—absolute alcohol, 171 
—boric acid, 169 
—carbolic acid, 168 
—Condy’s fluid, 170 
—corrosive sublimate, 168 
—creolin, 169 
—iodoform, 170 
—lysol, 169 

—permanganate of potash, 169 
—peroxid of hydrogen, 170 
Aorta, the, 285, 288, 300 
Apoplexy, cerebral, 251 

consciousness of patient in, 253 
diagnosis of, differential, 253 
symptoms, 252 
treatment, 252 
nursing, 253 
Appendicitis, 246-248 
catarrhal, 247 

perforation in, symptoms, 247 
causes of, 246 
symptoms, 247 
treatment, 247 

duties of the nurse in, 248 

433 


28 





434 INDEX . 


Appendicitis, treatment, operative, 
247 

Appendix vermiformis, 246, 307, 372 
Aqua fortis, 346, 372 
Arachnoid, 302 
Arm-fracture, treatment, 175 
Arsenic, antidotes, 210, 372 
Arteries, the, 300 

—aorta, 300 
—axillary, 301 
—brachial, 301 
—carotid, 300 
—femoral, 301 
—iliac, external, 301 
—iliac, internal, 301 
—peroneal, 301 
—popliteal, 301 
—pulmonary, 287 
—radial, 301 
—subclavian, 300 
—tibial, 301 
—ulnar, 301 
function of the, 285 
Articulations of bones, 297, 373 
of the extremities, 298, 299 
Asepsis, 168 

Asphyxia, from drowning, treatment, 
201. (See Respiration .) 
Asthma, 243 

position of patient in, 46 
Astragalus, the, 299 
Atropin, antidotes, 211, 373 
Auditory canal, 304 
“ Aura epileptica,” 255, 374 
Auricle (ear), 304 
Auricles (heart), 287 
Axillge, the, 299 

Baby, sick, carrying of the, 59. 

(See Infant .) 

Back-bone, 298 
Bacteria, 213 

Bag, nurse’s, equipment of, 25 
Bag of waters, 118 
Bandages, 178-186, 374 
—Desault, 181 
—divided, 181 
—figure-of-8, 181 
—four-tailed, 181 
—handkerchief, 183 
—many-tailed, 181 
—roller-, 178, 179 


Bandages:—rubber, 178 
—Scultetus, 182 
—spiral, 180 
—T-bandage, 182 
breast, 132 
materials of: 

—chalk and gum, 185 
—plaster of Paris, 184 
—silicate of soda, 185 
—starch, 185 

Bandaging, improper, gangrene from, 
179 

Barley-water enema, 63 
Bath, ear-, 114 
of infants, 264 
of the new-born, 262 
surgical, 149, 150 
Bath-thermometer, 81 
Baths : 

—foot-bath, 55 
—hot foot-baths, 84 
—hot-air bath, 84 
—shower-bath, 86 
—sponge-bath, 55 
—tub-bath, 55, 83 
action of, 81-90 

of acid steam-bath, 86 
of cold baths, 82 
of foot-bath, hot, 82 
of hot baths, 83 
of hot-air baths, 86 
of sheet-bath, 87 
of sitz-bath, 82 
of tepid baths, 82 
of vapor-baths, 81, 83 
of warm bath, 81 
in treatment of scarlet fever, 223 
temperature of, 81 
tepid, in typhoid cases, 219 
time for giving the, 81 
Bed, fracture, 174 
gynecologic, 141, 142 
obstetric, preparation of, 32, 121 
“ temporary,” 32 
of the rheumatic patient, 258 
preparation of, in case of burns or 
scalds, 199 

sick, changing the clothing of, 30 
preparation, 29. (See Bed-mak¬ 
ing.) 

Bed-clothing, arrangement of, for 
patient, 30 






INDEX. 435 


Bed-clothing, changing the, 30 
Bed-cradle, 34 
Bed-cushion, 35 
Bed-making, 30-33 

—cross-bed, 33 
—divided bed, 33 
—medical bed, 32 
—obstetric bed, 32, 121 
—surgical bed, 32 
for different cases, 32 
for gynecologic examinations, 33 
precautions in use of coverings, 
29 > 3 2 

Bed-pads and rings, 35 
Bed-pan, how to insert and remove 
the, 56 

Bed-patients, appliances for the 
relief of, 34 
—bed-cradle, 34 
—bed-rest, 34 
—bed-screen, 34 
—cushions, 3^ 

—pads, 35 
—rings, 35 

changing the bed-clothing of, 
3 °- 3 2 

preparation of beds for, 29, 32, 

. 33 

Bed-position of patient, symptoms 
indicated by, 46 
Bed-rest, 34 

Bed-screen, improvised, 34 
Bed-sores, cause and prevention of, 
54 , 375 

of typhoid patients, prevention of, 
221 

treatment of, 54 
water-beds in relief of, 33 
Beef, preparations of, for invalids, 

3 X 9 , 3 2 ° 

Beef-teas and extracts, 319-321 
Belladonna, antidotes, 211 
Beverages, invalid, 332-337 
permitted the sick, 314 
Bichlorid of mercury, 353, 362 
Bile, 292, 306 

digestive action of, 292 
Binder, obstetric, adjusting the, 128, 
129 

umbilical, of the new-born, 263 
Birth, normal, management after, 127 
management during, 126 


Bites, insect or mosquito, treatment, 
205 

of rabid animals, 212 
Black draught, 365 
Bladder, the, 308 
emptying the, 51, 69. 

(See Catheterization.') 
washing out the, 69 
Bland enemata, 63 
Bleeding, artificial, 92-94. 
from the lungs, 196 
from the stomach, 196 

(See Hemorrhages.) 
Blister, cantharidal, 108, 375 
“ perpetual,” 108, 376 
Blistering, therapeutic action, 105 
time to apply the irritant, 108 
Blisters, 106-108 
dressing of, 108 
Blood : 

—arterial, 193, 287 
—capillary, 193 
—venous, 193, 287 
composition of, 90, 91 
Blood-changes, 287, 288 
Blood-circulation, mechanism and 
course, 287 
physiology of, 285 
Blood-letting, 92-94 
Blood-poisoning, 165, 189, 376 
from diphtheritic discharges, 230 
Blood-supply, fetal, 118 
Blood-vessels, the, 300 
Blue mass, 362 
pill, 3 62 

vitriol (bluestone), 353 
Body-linen, changing, 52, 53 
Body-temperature, 41 

conditions influencing, 41 

fatal indications, 42 

in disease. (See Temperature.) 

influence of, on the pulse-rate,42,43 

normal, 41 

of infants, 42 

subnormal, 42 

sudden rise or fall, significance of, 
42, 44 

taking of the, 43 
caution in, 43 
variations in, 41 
varieties of, 42 
Boil, 192 





43 ^ 


INDEX. 


Boil, “ blind,” 192 
Bone-repair, 173 

Bones, broken. (See Fractures .) 
of the body, number, 296 
of the extremities, 298 
of the skull, 297 
of the trunk, 297 
Borax, 366 

Bowel, obstruction of, of infancy, 
symptoms and treatment, 
271 

protrusion of, of infancy, 275 
Bowel-movements. (See Movements.) 
Bowels of the patient, symptomatic 
condition of, 50 
Brain, the, 301 

compression of, symptoms, 204 
treatment, 204 

concussion of, symptoms, 204 
treatment, 204 
nerves of the, 301 
Brain-disease, the sick-room in, 29 
Breast-bandage, 132 
Breast-bone. (See Sternum.) 

Breast massage, 131 
Breasts, puerperal, care of, 131 
Breath of the patient, odor of, 48 
Breathing, abdominal, 44 
normal, 44 

of the patient, character of, 48 
stertorous, indications of, 48 
thoracic, 44 
(See Respiration.) 

Brimstone, 367 
Broad ligaments, 309 
Bronchii, the, 305 
Bronchitis, symptoms, 242 
treatment, 242 
Broths, 321, 323 
Bruises and cuts, treatment, 204 
Burns, acid, treatment, 206 

of the eye, treatment, 207 
alkali, treatment, 206 

of the eye, treatment, 207 
death from, causes, 198 
degrees of, 197 

—first degree, result, 197 
—second degree, result, 198 
—third degree, result, 198 
Burns and scalds, 197-200 
complications of, 199 
treatment of, 199, 377 


“Callus,” 173 
Calomel, 362, 377 
Cantharidism, 106 
Cantharis, therapeutic action of, 107 
Capillaries, the, 285, 288, 300 
Capsules, medicine, 75 
Carbolic acid, antidotes, 209 
Carbonic-acid gas, 289, 290 
poisoning, antidotes, 209 
Carbuncle, 192, 378 
Cardiac dilatation, 291 
Cases, emergency, duties of the nurse 
in, 151 

medical, nursing in, 39-115 
Castor-oil enema, 61 
Catgut, sterilization of, 171 
Catheter, selection of, 68 
Catheterization of patient, 5 1 , 68 
after abdominal operation, 164 
in the puerperium, 129 
operation, the, 69 
precautions in, 68 
“Caul,” the, 127 
Caustic lime, antidotes, 210 
Cecum, the, 307, 379 
Cerate, cantharidal, 107 
Cerebellum, the, 301 
Cerebrum, the, 301 
Cervix, the, 308 
Cesarean section, 136, 380 
Charts, sick-room, 28 
Chest. (See Thorax.) 
Cheyne-Stokes respiration, 45, 380 
Chilblains, cause and treatment, 207 
Childbirth. (See Labor.) 

Children, diseases of, 270-281 
etherization of, 155 
management of, nurse’s, 281 
sick, moving, 59 
nursing of, 262-283 
Chills of the patient, reporting of, 49 
stages of, 49 
treatment, 49 

Chittern bark (sacred bark), 357 
Chloral, antidotes, 211 
Chloroform, administration of, 155 
anesthesia, death from, 156 

symptoms to be watched for, 

155. 156 

blister, 108 

Cholera infantum, treatment, 272 
morbus, symptoms, 249 



INDEX. 437 


Cholera morbus, treatment, 249 
Chorea, 279, 381 

complications of, 280 
treatment, 280 
Chyle, 292 
Chyme, 292 
Circulation, portal, 288 
pulmonary, 288 

systemic, 289. (See Arteries , and 
Blood-circulation.') 
Clavicle, the, 298 
Cleanliness, antiseptic, 122, 247 
Clothing, bed, changing of the, 30, 

body-, changing the, 52 
catching fire, what to do, 203 
of the new-born, 263 
Coagulation, blood-, 90 
Coal-tar camphor, 362 
Coated tongue in fevers, 46, 47 
Coccyx, the, 298 
Cochlea (ear), 305 
Cold, application of, 101 
bath, action of, 82 
exposure to, death from, 207 
pack, action of, 88 
Cold-water treatment of sunstroke, 
200 

Colic, infant, 270 
Collapse, 161 
Collar-bone, 298 

fracture, treatment, 175 
Collodion, cantharidal, 107 
Colon, the, 307 
“Colostrum,” 131 
Coma vigil, 215 
Compress, breast, 132 
Compression, brain, symptoms, 204 
Conception, time of occurrence, 116 
(See Pregnancy.) 
Concussion, brain, symptoms, 204 
Confinement, date of, how to esti¬ 
mate, 116 

table for computing the, 343 
nurse’s preparations for the, 120 
Constipation of pregnancy, 119 
Consumption. (See Phthisis.) 
Contagion, spread of, prevention, 214 
Convalescence, dietary in, 315 
of scarlet-fever patient, 225 
of typhoid patient, management, 
221 


Convalescence, wrap for patient 
during, 36 

Convulsions in cerebral apoplexy, 
252 

of infancy, 273 
treatment, 274 
of pregnancy, 119 
of whooping-cough, treatment, 239 
puerperal, 135 
uremic, 224, 250 
treatment, 224 

Cord, navel. (See Cord, umbilical.) 
spinal, the, 300 

composition of, 302 
nerves of the, 302, 303 
umbilical, 118,263 

complicating labor, 126 
dressing the, 263 
tying the, 127, 128 

preparing the string for, 122 
Corrosive sublimate, 362 
antidotes for, 210 
Cough of patient, nature of, 47 
Counter-extension, 187 
Counter-irritants, 104-10S 
Counter irritation, 104 
Coxalgia, 2S0 

Cradle, bed-, improvised, 34 
Cream of tartar, 364 
Crisis, 44 
Cross-bed, 33 

Croton oil (counter-irritant), 106 
Croup, membranous, 238 
nursing-treatment, 238 
symptoms of, 238 
simple, 237 

nursing-treatment, 237 
symptoms, 237 

Cry, infant’s, signification of, 277 
Cupping, dry, 93 
wet, 94 

Cutis (derma), 296 
Cuts and bruises, treatment, 204 
Cyanid of potassium, antidote, 209 
Cyanosis, 198 
cause of, 47 
Cystitis, 51, 69 

Dead, caring for the, 261 
Death from burns, 197, 198 

from chloroform anesthesia, symp¬ 
toms, 156 





438 INDEX. 


Death from contagious diseases, prep¬ 
aration of the body after, 235 
from ether, impending, symptoms 
of, 1 53» 154 

from exposure to cold, 207 
from sepsis, responsibility for, 166 
“ Decussation ” of nerve-fibres, 254, 
302 

Deformity from burns or scalds, 200 
Deglutition, 291 
Delirium of scarlet fever, 225 
of small-pox, 227 
of typhoid fever, 215 
of the patient, character of, 48 
Deodorant defined, 167 
Desserts, recipes for, 329-332 
Diabetes, 258 
insipidus, 258 
mellitus, 258 

first symptoms of, 293 
treatment of, 258 
Diaphragm, 300 
Diarrhea, acute, treatment, 250 
infant, treatment, 272 
of pregnancy, 119 
Diet after gynecologic operation, 143 
before a surgical operation, 149, 

*5° 

during the puerperium, 130 
following appendicitis, 248 
following peritonitis, 246 
following surgical operation, 163 
in bronchitis, 243 
in cerebral apoplexy, 253 
in cerebro-spinal meningitis, 251 
in cholera morbus, 250 
in convalescence, effect of change, 
317 

of typhoid patient, 221 
selection of, 315 
in croupous pneumonia, 241 
in deficient milk-secretion, 132 
in diabetes, 258 
in diarrhea, 250 
in diphtheria, 230, 231 
in dysentery, 249 
in epilepsy, 256 
in gastritis, 245 
in measles, 229 
in neurasthenia, 257 
in rheumatism, 258 
in small-pox, 228 


Diet in typhoid fever, 217, 218 
in whooping-cough, 239 
raw-meat, 320 

Dietary of feeble patients, 57 
Diet-kitchen outfit, 314 
Digestion: 

—alimentary canal, 290 
—deglutition, 291 
—intestinal digestion, 292 
—mastication, 291 
—stomach digestion, 292 
organs of, 290, 305 
Digitalis, antidotes, 211 
Diphtheria, 229-231 

antitoxin treatment of, 230 
fumigation after, 228 
intubation in, 233 
nourishment and stimulants in, 230 
nursing-treatment, 230 
symptoms, 229 
tracheotomy in, 231 
Discharge from nose, ears, or eyes, 50 
Diseases, contagious, defined, 214 
fumigation after, 234 
spread of, media for the, 214 
prevention of, 214 
functional and idiopathic, 239-262 
infectious, cause of, 213 
defined, 213 
“miasmatic,” 214 
of childhood, 279-283 
—chorea, 279 
—incontinence, 279 
—meningitis, 278 
—mumps, 279 
—typhoid fever, 278 
of children, surgical, 280-283 
of infancy, 270-277 

—bowel obstruction, 271 
—cholera infantum, 272 
—colic, 270 
—convulsions, 273 
—diarrhea, 272 
—from teething, 274 
—ophthalmia neonatorum, 

275 

—paralysis, 276 
—protrusion of the bowel, 275 
—rickets, 273 
—snuffles, 276 
—thrush, 270 
—tongue-tie, 276 





INDEX. 


Diseases of infancy :—vomiting, 272 
—worms, 274 
of the skin, 259-261 
Disinfectant defined, 167 
Disinfection, corrosive-sublimate, 235 
following diphtheria, 231 
following measles, 229 
following small-pox, 228 
heat, 171 

in scarlet-fever cases, 223 
in typhoid fever, 216, 217 
in typhus fever, 226 
of excreta of consumptives, 236 
of typhoid fever, 216 
surgical, and materials, 167 
Dislocation, compound, treatment, 
176 

of jaw, treatment, 176 
Dislocations, 176 
Disorders of pregnancy, 119 
Disturbances, functional, relief of, 
59-70 

—catheterization, 68 
—douches, 65 
—enemata, 59 
—rectal feeding, 64 
—washing out the bladder, 

69 

—washing out the stomach, 

70 

Dose list, 346 
Douche, cold, 88 
ear, 113 

head, method of giving, 87 
vaginal, easy way to give, 67 
insertion of tube in, 66 
position of patient for, 66 
time for giving, 67 
Douches, 65-68 

—antiseptic, 67 
—rectal, 67 
—vaginal, 65 
genital or perineal, 68 
Drainage after surgical operations, 
164, 165 
gauze, 165 
tube, 164 

Drainage-tube after operation, atten¬ 
tion required, 164 

Dress of nurse and personal habits, 

2 5 

in contagious diseases, 236 


439 

Dress of patient for surgical opera¬ 
tion, 150 

Dressing of burns or scalds, 199 
Dressings, surgical, 176-188 
—dry dressing, 177 
—tents, 177 

—water-dressing, 176, 177 
management of, 177 
removal of, in burns and scalds, 
199 

Drip-sheet (sheet-bath), 87 
Drops, administering, 74 
and minims, 341 
Dropsy, 257 

complicating scarlet fever, 224 
of glottis from scalds, 198 
Drowning, 201 
Drug-habit, 71, 72 
Drugs, absorption of, rapidity of, 70 
action of, 71 

“cumulative,” 71 
Drum-membrane of ear, 304 
Duct, lachrymal, 112 
Duodenum, the, 307 
Dura mater, 302 
Dysentery, symptoms, 248 
treatment, 249 
Dysmenorrhea, 205 
Dyspnea of bronchitis, relief of, 242 

Ear, the, 303-305 

—the auricle, 304 
—internal, 305 
—middle, 305 

middle, inflammation of, causes 
and treatment, 224 
obstruction in the, removal of, 204 
syringing of the, 113 
Ear-bath, 114 
Ear-douche, 113 

Ears, foreign bodies in, caution in 
treating, 115 

liquids in the, inserting, danger of, 
114, 115 
Eclampsia, 135 
Eczema, 259 

Edema of glottis from scalds, 198 
Eggs, recipes for cooking, 325, 326 
Embolism, 136 

Emergencies, common, 193-212 
duties of the nurse in, 151, 212 
Emetics in poisoning, 209 




440 


INDEX . 


Empyema, 243 

nurse’s duties in a case of, 244 
treatment of, 244 
Endothelium, 296 

Enema, administration of, to an un¬ 
conscious patient, 57 
method of giving an, to an infant, 
271 

stimulating, in shock, 160 
indications of action of, 63 
retention of, how to secure, 61 
Enemata, 59-63 

—astringent, 62 
—bland, 63 
—evacuant, 60 
—high, 61 
—purgative, 61 
—stimulating, 63 
in surgical operation, 150 
method of administering, 60 
stimulating, in septicemia, 167 
Epidermis, 296 
Epilepsy, 254 

the attack, periods of, 255 
treatment of, 255 
Epistaxis, 197 
Epithelium, 296 
Epsom salt, 362 
enema of, 62 
Ergot after labor, 128 
antidotes for, 210 
in hemorrhage of pregnancy, 120 
of puerperium, 134 
Eruption of measles, 228 
of scarlet fever, 222 
of small-pox, 226, 277 
of typhoid fever, 216 
of typhus fever, 225 
Erysipelas, 189 
Eserin salicylate, 363 
sulphate, 364 
Esophagus, the, 290 
Ether administration, method of, 
153 

to children, 155 
anesthesia, caution in, 153 
dangerous signs in, 153, 154 
death from, impending:, symp¬ 
toms, 153, 154 
during labor, 125 
nausea and vomiting following, 
154 , 155 


Ether anesthesia, obstruction to 
breathing in, method of 
preventing, 153, 154 
preparations for, 152 
rules for, 153 

symptoms to be observed by the 
nurse in, 154 
cone, improvised, 152 
Etherization, 152-15 5 
Etiquette, hospital, 23 
in private nursing, 24 
Eustachian tube, 305 
Evacuant enema, administration of, 
60 

Examination, gynecologic, positions 
for, 137 

preparation of the patient for, 
137 

Exanthemata, acute, 214 
Excreta. (See Movements .) 

removal of, from sick-room, 38 
Excretions of the body, 293 
Exhaustion from heat, 200 
Expectoration of patient, character 
of, 47 

Expectorations in croupous pneumo¬ 
nia, disposition of, 241 
of consumptives, disposition of, 
236 

Expiration, 289 

Expression, facial, in hemorrhage, 
I35» 161, 194, 219 
in peritonitis, 245 
in septicemia, 166 
in shock, 160 
in sickness, 47 

Expulsion, mechanism of, 124 
regulating the, 126 
Extension, 187, 188 
Eye, acid or alkali burns of, treat¬ 
ment, 207 

foreign body in the, removal of, 
205 

inserting a drop in the, method of, 

112 

ointment, method of, 113 
syringing the, 113 
Eye-drops, application of, 112 
Eyes, the, 303 

inflammation of, of infancy, 275 
syringing the, of infants, method 
of, 275 



INDEX. 44i 


Face, expression of, in hemorrhage, 

I 35 » l6l > l 94 , 219 
in peritonitis, 245 
in septicemia, 166 
in shock, 160 
in sickness, 47 
Fainting, treatment, 201 
Faintness following discharge of the 
amniotic fluid, 124 
Fallopian tubes, the, 309 
Fascia, 300 

Feces. (See Movements .) 

Feeding, artificial, of the new-born, 
265 

feeble patients, 56 
infant, rules for, 267 
rectal, 64 

of an unconscious patient, 57 
the sick, 56 

general rules, 311-317 
Femur, the, 297, 299 
Fetus, movements of, 118 
nourishment of the, 117, 118 
Fever, enteric, 215 
intermittent, 214 
low, 215 
malarial, 214 
nervous, 215 
scarlet. (See Scarlet.) 
slow, 215 

typhoid. (See Typhoid.) 
typhus. (See Typhus .) 

Fevers, coated tongue in, 46, 47 
Fibxin, blood, 90 
Fibula, the, 299 

Finger-nails of patient, condition of, 

. 5 ° 

Fire, accidents from, 203 

sick-room, management of, 36 
Fistula, 192 

Fits, epileptic. (See Epilepsy.) 
Flatulence, treatment of, 206 
Flaxseed enema, 63 

poultice in removing a slough, 

97 

preparation of, 95, 96 
Fomentation, the, action of, 91 
Fomentations, 94, 95 
—hot-water, 94 
—laudanum, 95 
—mustard, 95 
—turpentine, 95 


Fontanel, anterior, closing of the, 
268 

Food, administration of, before sur¬ 
gical operation, 150 
artificial, for the new-born, 265 
Meigs’, 267 
infant, 326 

record of, taken by patient, 46 
serving the, proper method of, 56, 

311 

Food-changes in the stomach, 292 
Foods, invalid, recipes for, 317-332 
—beef-teas and extracts, 319 
—broths, 321 
—desserts, 329 
—farinaceous, 317 
—miscellaneous, 325 
—oysters, 322 
—prepared milk, 327 
—puddings, 323 
—soups, 324 
—toasts, 328 
Foot-bath, 55 
hot, 84 

action of, 82 
Forearm, the, 299 

Foreign bodies, obstruction due to, 
204 

Fracture, moving of the patient in, 31 
signs of a, 173 
Fractures, 172-175 

management of, 53» J 73 
nurse’s preparations for the surgeon 
in, 174 

removal of patient’s clothing in, 
53 > l 73 , 174 

splints in, application of, 186 
varieties of, 172 
Friar’s balsam, 349 
Frost-bite, cause and treatment of, 
207 

complications of, possible, 207 
Fumigation after contagious diseases, 
234-236 
moist, 235 

preparation of sick-room for, 236 
sulphur-fume, 234 

apparatus for burning the sul¬ 
phur, 234 

Functional disturbances. (See Dis¬ 
turbances.) 

Furuncle. (See Boil.) 




442 


INDEX. 


Gall-bladder, 306 
Gangrene, 191 

dry or “ senile,” 191 
symptoms of, 191 
from improper bandaging, 179 
moist, symptoms, 191 
Gargles, 110 

Gas, rectum, passage of, after opera¬ 
tion, 50, 164 

Gas-accumulation, rectal, relief of, 
246 

Gastric juice, 292 

digestive action of, 292 
Gastritis, symptoms, 244 
treatment, 245 

Germs, disease, conditions necessary 
for development of, 213 
media of leaving the body, 213 
of phthisis, dissemination of, 236 
Gland, lachrymal, 112 
parotid, function of, 292 
Glauber’s salt, 366 
“ Globus hystericus,” 257 
Glossary, 369 

Glottis, edema of, from scalds, 198 
Glycerin enema, or substitutes, 61, 62 
Golden seal, 359 
Gruels, 318 

Gums of the patient, condition of, 46 

Hair, patient’s, dressing of, 53 
Hand, palm of the, bleeding from, 
checking, 196 
Hartshorn, 347 
Head-accidents, 203 
Head-douche, 87 
Healing by first intention, 188 
by second intention, 188 
under a blood-clot, 189 
Heart, the, 300 
its structure and valves, 286 
neuralgia of the. (See Angina.) 
Heart-failure, unconsciousness from, 
treatment, 201 
Heat as a disinfectant, 171 
dry, application of, 101 
moist, 94 

of inflammation, cause of, 91 
Heat-exhaustion, treatment, 200 
Heel-pad, 35 
Hematemesis, 196 
Hemiplegia, 254 


Hemoptysis, 196 

Hemorrhage, body-temperature in, 
160 

cerebral, 251 
checking, by flexion, 194 
by tourniquet, 195 
fainting in, 195 
of venous, 195 
with ice, 195 

following surgical operation, 161 
from the lungs, treatment of, 196 
from the nose, treatment, 197 
from the palm, checking, 196 
from the stomach, treatment, 196 
of amputation-stump, checking, 194 
of pregnancy, treatment, 120 
of typhoid fever, 219 
treatment, 220 
post-partum, 133 
treatment, 133, 134 
puerperal, 133 
stimulants in, 162 
symptoms of, 194 
thirst in, 196 
treatment, 194 
Hemorrhages: 

—primary, 193 
—recurrent, 193 
—secondary, 193 
Henbane, 359 
Herpes zoster, 260 
Hiccough, cause and relief, 52 
of the patient, character of, 51 
High enema, administration of, 61 
“ Hinge-joint,” 299 
Hip-joint disease, 280 
Hoffmann’s anodyne, 354 
Hot bath, action of, 83 
Hot-air bath, 84 
Humerus, the, 298 
Hunger, relief of, by rectal feeding, 
8 3 

Hydrocyanic acid, antidotes, 209 
Hygiene of children, 281 

of the sick-room, 29, 36, 290 
—air, 37 

—temperature, 36 
—ventilation, 37 

personal, of patient, following ap¬ 
pendicitis, 248 

Hyperpyrexia, body-temperature in, 
42 



INDEX ; 


Hypnotics, action of, 72 
Hypodermatic tablets, list of, 342 
Hysterectomy, after-care in, 165 
Hysteria, 256 

diagnosis of, from epilepsy, 256 
forms of, 256 
treatment of, 256 

Ice, action of, in inflammatory pro¬ 
cess, 91 

in checking hemorrhage, 195 
in treatment of sunstroke, 200 
serving of, to the sick, method of, 
57 

Ice-bags, 103 
Idiosyncrasy defined, 71 
Ileo-cecal valve, 307 
Ileum, the, 307 
“ Immunity” defined, 214 
Incontinence of urine, 50, 279 
in pregnancy, cause of, 119 
Incubation of typhoid fever, period 
of, 215 

period of, defined, 213 
Incubator, improvised, 269 
Indian-meal enema, 63 
Indigestion, infant, treatment, 271 
Infancy, diseases of, 270-277 
Infant, bathing the, 264 

cry of the, signification of, 277 
crying of the, causes of, 265 
defecation of the, 264 
development of the, 268 
dressing the, 263 
feeding of the, artificial, 265 
care of the utensils, 266 
periods of, 268 
rules for, 267 
food. (See Fool.) 
new-born, care of, 262 
nursing of the, 265 
paralysis, 276 

pulse of, at birth, 41, 269, 277 
how to take, 277 
urination of the, 264 
weaning, time for, 268 
Infants, body-temperature of, 42 
premature, care of, 269 
pulse-rate of, 41, 269, 277 
respiration of, 45, 277 
syringing the eyes of, method of, 
275 


443 

Infection, diphtheritic, conditions fa¬ 
voring, 231 
Inflammation, 90 

from frost-bite, treatment, 207 
symptoms of, 91 
treatment of, 91 
Influenza (grippe), 239 
complications of, 240 
symptoms, 239 
treatment, 239 
Inhalations of medicines, 80 
—dry, 80 
—moist, 80 

Injection, intravenous, defined, 78 
of medicines, hypodermatic, 76 
(See Enemata, and Douches .) 
Insanity following hysterectomy, 

*65 

puerperal, 135 
Insect bites and stings, 205 
in the ear, removal of, 204 
Insomnia, treatment, 206 
Inspiration, 289 
Intestines, the, 291, 307 
lengths of, 307. 

Intoxication, diagnosis of, from apo- 
plexy, 253 

Intubation in diphtheria, 233 
duties of the nurse, 233 
in scalds of the glottis, 198 
Inunction, mercurial, 78 
Inunctions of medicines, 78 
Involution, 125, 131 

method of promoting, 128 
Iodin, antidotes, 210 

tincture of (counter-irritant), 106 
Ipecac, 359 
Itch, 259 

Ivy-poisoning, treatment, 210 

Jacket-poultice, preparation of, 97 
James’ powder, 348 
Jaundice, cause of, 306 
Jaw dislocation, treatment, 176 
fracture, treatment, 175 
Jellies, recipes for, 329-332 

Kidney, inflammation of. (See 
Nephritis .) 

Kidneys, the, 308 

Kitchen, the, as an operating-room, 

I 45 > I 5 1 * l 5 2 




444 


INDEX. 


Knee-cap, 299 
Koumyss, 327 

Labor, 122-129 
duration of, 126 
normal, birth in, 122, 123 
conduct of, 126-129 
first sign of, 123 
stages of, 123-126 
preparations for, nurse’s, 120 
—accessory, 121 
—aseptic cleanliness of nurse, 
* 122 

—of the bed, 121 
—of the patient, 120 
—special articles needed, 122 
Labor-pains, 123, 124 

false or true, differential diagnosis, 
120, 123, 124 
Labyrinth (ear), 305 
Lactation, 131 

La grippe. (See Influenza.') 
Laudanum, 363 
Lavage, 70 

in gastritis, 245 
Laxatives, administering, 75 
Leeches, application of, 92, 93 
Leeching, 92 

Leg fracture, treatment in, 175 
Leiter coil, 101-103 
Leucorrhea, cause of, 52 
Licorice-root, 358 
Ligation, 171 
Lightning-stroke, 201 
Limbs, swelling of, in pregnancy, 
cause of, 119 

Lime-water, recipe for, 337 
Liniments, no 
Liver, the, 306 
Lochia, 130 

Lockjaw. (See Tefantts.) 
Logwood, 358 
Lotions, no 
Lugol’s solution, 359 
Lunch, invalid’s, 328 
Lung, gangrene of, expectoration in, 
47 

Lungs, the, 305 

function of the, 287 
hemorrhage from the, 196 
tuberculosis of. (See Phthisis.) 
Luxations. (See Dislocatio?is.) 


Lying-in, period of, 129 
Lymphatics, 300, 301 
Lysis, 44 

M ad-dog, bites by, treatment, 212 
Magnesia, calcined, .362 
Husband’s, 362 
Massage, 108-no 
breast, 131 

in infant paralysis, 276 
in neurasthenia, 257 
in paralysis, 254 
in rheumatism, 259 
skill required in applying, 109, IIO 
therapeutic effect of, 109 
Mastication, 291 
Mastoid process, 305 
Measles, 228 

complications of, 229 
nursing-treatment, 228 
symptoms, 228 
Meat cure, 320 
raw, diet, 320 
Meatus urinarius, 308 
Medicine-glasses, care of, 73 
Medicines, absorption of, rapidity, 70 
action of, 71 

—cerebral, 72 
—hypnotic, 72 
—sedative, 72 
—stimulant, 72 
—tonic, 72 
time required for, 71 
administration of, 70-80 
by inhalation, 80 
by inunction, 78 
by the mouth, 74 
hypodermatic, 76 
per rectum, 76 
precautions in handling, 72 
Medicine-spoons, care of, 73 
Medulla oblongata, 301 
Melancholia, puerperal, 135 
Meningitis, cerebral, symptoms, 278 
treatment, 279 

cerebro-spinal, symptoms, 251 
treatment, 251 
Menstruation, 52 

painful, treatment, 205 
retarded, relief of, 82 
Mercury, inunction of, method of, 
78, 79 



INDEX. 445 


Milk, mother’s, first appearance of, 

! 3 r 

not to be given before an abdomi¬ 
nal operation, 149, 150 
sterilization, 266 
sterilized, 335 

use of, in typhoid fever, 218 
Milk-leg, 135 
Milk-secretion, scanty, 132 
Mineral waters, 337-339 
Molasses enema, 62 
Monoplegia, 254 
Morphia, antidotes, 211 

is the nurse justified in giving, 
248 

Morphin, 362 

Mouth, patient’s, cleansing of, 53 
state of the, 46 

Movements (bowel) after labor, 130 
character of, 50 
color of, 50 

indications from, 50 
composition of, 50 
disinfection of, in contagious dis¬ 
eases, 215 

in typhoid fever, 216 
disposition of, from contagious 
cases, 215 

in infant, bowel'obstruction, 271 
colic, 271 
diarrhea, 272 
in typhoid fever, 216, 278 
of the new-born, 264 
Moving the patient, 57 
Mumps, symptoms, 279 
treatment, 279 
Muriatic acid, 346 
Muscles of the body: 

—involuntary, 299 
—longest, 299 
—smallest, 299 
—sterno-cleido-mastoid, 300 
—the diaphragm, 300 
—voluntary, 299 

Mushrooms, poisonous, antidotes, 212 
Mustard plaster, 106 

Napkins during the puerperium, 130 
Narcotics, action of, 72 
Nausea and vomiting, 46 

following etherization, 154, 155 
of pregnancy, 119 


Nephritis complicating scarlet fever, 
224 

Nerve-fibres, motor, 302 
sensory, 302 
Nerves, the, 302 

action of, impulsive, 302, 303 
reflex, 303 
of the brain, 301 
of the spinal cord, 302, 303 
vasomotor, 303 
Nervous system, the, 302 
Neuralgia, heart. (See Angina.') 
Neurasthenia, 257 
treatment, 257 
New-born, bathing the, 262 
care of the, 262-269 
dressing the cord, 263. 

(See Infant.) 

Nightingale wrap, 36 
Nipple, cracked, 132 
Nitrate of amyl, antidotes, 212 
Nitric acid, antidote, 210 
Nitromuriatic acid, 346 
Nose, the, 303 

obstruction in the, removal of, 205 
spraying the, ill 
Nose-bleed, 197 
Nurse, the, 17-28 

aseptic cleanliness of, in surgical 
operations, 122, 247 
in obstetric cases, 122 
compensation of, 19 
conduct of the, in emergencies, 212 
dress and personal habits, 25 
in contagious diseases, 236 
in operating-room, 156 
duties of the, 20 

—in circumstances of envi¬ 
ronment, 21 

—in conversing with patients, 
21, 22 

—in dissensions, 22 
—in operating-room, 156 
—in preparations lor the 
night, 21 

—in preservation of confi¬ 
dences, 21, 22 

—to her superiors in hospital 
practice, 23 
—to the doctor, 22 
—to the family, 20 
—to the patient, 20 




446 INDEX. 


Nurse, duties of, in emergency cases, 
15 1, 212 

night duty of, responsibility of, 19 
personal bearing, 18 
care, 18 

in contagious diseases, 236 
qualifications of, 19 
responsibilities of, 17 
sympathy and kindness of the, 
toward the patient, 282 
Nurse’s equipment, 25 

for an obstetric case, 122 
hands, sterilization of, importance 
of, 136, 221. 

management of children, 281 

meals, 21, 22 

records. (See Record .) 

Nursing, hospital, etiquette in, 23 
versus private, 23 
in accidents and emergencies, 
172-193 

in common emergency cases, 193- 
212 

in general surgical cases, 144-172 
in gynecologic cases, 137-144 
in obstetric cases, 115-137 
in special medical diseases, 213- 
262 

of sick children, 262-283 
private, etiquette in, 24. 

(See Patient.) 

Nursing of infant by the mother, 265 
Nutritive enema, administration of, 
64 

formulae for, 64 
frequency and amount of, 64 
retention of, 64 
stimulating, formula, 63 
Nux vomica, antidotes, 211 

Observations in medical cases, 39- 
52 

—body-temperature, 41-44 
—the pulse, 39-41 
—the respiration, 44 
—the symptoms, 45 
of symptoms : 

—chills, 49 

—cough and expectoration, 47 
—delirium, 48 
—hiccough, 51 
—pain, 47 


Observations of symptoms :—sleep, 
48 

—the bladder, 50 
—the bowels, 50 
—the breath, 48 
—the facial expression, 47 
—the menstruation, 52 
—the mouth, 46 
—the skin, etc., 49 
—the taking of food, 46 
—the tongue, 46 
Oil of chenopodium, 368 
of vitriol, 347 
Oils, administering, 75 
Ointment, mercurial, inunction of, 
78-80 

Olive-oil enema, 61 
Omentum, the, 308 
Operating-room, nurse’s duties in 
the, 156 

preparation of, for surgical case, 
144 

selection of, 145 
the kitchen as an, 141, 152 
Operating-table, improvised, for sur¬ 
gical cases, 145, 146 
Operation: 

gynecologic, after-care of patient, 
143. 

examination for, preparation of 
patient, 137 
positions for, 137 
preparation for, 140 
surgical, after-care of patient, 159 
arranging the patient for, 158 
cleansing the part for, 149 
diet before, 149 
disinfection and materials, 167 
dressing the patient for, 150 
emergency, duties of the nurse 
in, 151, 152 
food before, giving, 150 
preparation for the, articles re¬ 
quired, 146, 147 
of patient, 152 
sequelae of operation, 159 
—collapse, 161 
—hemorrhage, 161 
—shock, 159 

Operations, abdominal, after-treat¬ 
ment, 163, 164 
catheterization after, 164 



INDEX. 


447 


Operations, surgical, 144-172 

antiseptic cleanliness of nurse 
in, 122, 247 

emergency, duties of the nurse 
in, 151 

Ophthalmia neonatorum, 275 
Opisthotonos, 190 
Opium, antidotes, 211 

-poisoning, diagnosis of, from 
apoplexy, 253 
Orbits, eye, 303 
Organs, circulatory, 285, 300 
digestive, 290, 305 
of generation, female, 308 
respiratory, 305 
sensory, 301 
urinary, 293, 308 
function of, 293 
Os uteri, the, 308 
Ovaries, the, 309 
Oxalic acid, antidotes, 209 
Oxygen, deficient, effect of, 290 
Oysters, recipes, 322 

Pack, cold, 88 
hot, 89 
partial, 90 
“ Packed feces,” 50 
Pads, obstetric, antiseptic, 121 
Pain from burns, 198 

inflammatory, cause of, 91 
reporting the, of the patient, 47 
Pancreas, the, 307 
Pancreatic juice, 292 

digestive action of, 292 
Paracentesis in pleurisy, 243 
Paralysis, 254 

changing the patient’s clothing in 
case of, method, 53 
hysterical, 257 
of infancy, 276 
treatment of, 254 
Paraplegia, 254 
Paregoric, 363 
Paresis, 254 

Paris green, antidotes, 210 
Patella, the, 299 
Patient, the, 39-114 

administration of medicines, 70-80 
—by the mouth, 74 
—by the rectum, 76 
—hypodermatic, 76 


Patient, the, administration of med¬ 
icines :—by inhalation, 80 
—inunction, 78 

after-care of, in gynecologic opera¬ 
tions, 143 

in surgical operation, 159 
after-treatment of, in amputations, 

l6 3 

in abdominal operations, 163 
in surgical operation, 163 
arranging the, for surgical opera¬ 
tion, 158 
bathing the, 55 
bodily care of, 52-59 
body-temperature of the, 41 
bowels of the, condition of, 50 
breath of, character of, 48 
breathing of the, character of, 49 
changing the bed-clothing of, 30, 

3 1 

the body-clothing of, 52 
chills of the, reporting of, 49 
convalescent, wrap for, 36 
cough of, reporting the, 47 
delirium of the, character of, 48 
dressing the, for surgical opera¬ 
tion, 150 

expectoration of the, 47 
expression of, facial, 47 
external applications to, general 
and local, 81-115 
feeding of the, 56 
rectal, 64 

food taken by, record of, 46 
functional disturbances of, relief 
of, 59-70 

—catheterization, 68 
—douches, 65 
—enemata, 59 
—rectal feeding, 64 
—washing out the bladder, 69 
—washing out the stomach, 70 
gynecologic, after-care of, 143 
—the diet, 143 
—vaginal dressings, 144 
—vaginal tampons, 143 
positions of, for examination, 

l 37 . . 

preparation of, for examination, 

137 

for operation, 140 
helpless, carrying the, 59 



448 INDEX. 


Patient, helpless, lifting of the, 57, 

58 

hiccough of the, character of, 51 
menstruation of the, 52 
mouth of the, state of, 46 
moving of the, 57 

with fractured limb, 31 
nausea and vomiting of, 46 
observation of symptoms in, 45 
obstetric, preparation of, 120 
pain of the, reporting the, 47 
position of, symptoms in, 46 
in giving vaginal douche, 66 
in peritonitis, 246 
preparation of, for surgical opera¬ 
tion, 149, 152 

the morning of the operation, 

150 

pulse of the, 39 
respirations of the, 44 
serving the food to the, 311 
—beverages, 314 
—necessity for cleanliness, 
313 

—preparing the tray, 312 
—preparation of the patient, 

—taking the meal, 313 
—varying the bill of fare, 

3 I2 > 3 X 3 

serving liquids to the, 312 
skin, etc. of the, condition of, 49 
sympathy and kindness of the 
nurse toward the, 282 
toilet of the, 53 

unconscious, administering med¬ 
icine to, 73 
rectal feeding of, 57 
urine of the, condition of, 50 
vital powers of, lowest ebb, 36 
Patients, bed-, appliances for the re¬ 
lief of, 33, 34 

delirious, caution observed with, 
48 

Pelvis, the, 298 

female, contents of, 298 
Pepper, cayenne, 357 
Peppermint camphor, 362 
Peptonized beef-tea, 320 
milk, 327 
toast, 328 
oysters, 322 


Perforation, bowel, in typhoid fever, 
278 

complicating typhoid fever, 220 
Pericardium, 300 
Periosteum, 296 
Peritoneum, the, 307 
inflammation of. (See Peritonitis .) 
Peritonitis, 245 
causes of, 245 

position of patient in, 46, 247 
septic, 165-167 
symptoms of, 245 
treatment, 246 

Pertussis. (See Whooping-cough .) 

Peruvian bark, 352 

Phenacetin, danger in use of, 239 

Phenic acid, 346 

Phenol, 346 

Phenozone, 348 

Phlegmasia dolens, 135 

Phosphoric acid, antidote, 210 

Phosphorus, antidotes, 210 

Phthisis, 236 

acute, symptoms, 237 
chronic, 237 

danger of contagion by contact 
with patient, 236 
forms of, 237 

nursing of patients with, 237 
Physiology, 285-296 
of blood-circulation, 285 
of digestion, 290 
of respiration, 289 
of urinary function, 293 
Pia mater, 302 
Picrotoxin, 353 
Pillows, bed, changing the, 31 
Pills, administering, 75 
Pinna, the, 304 

Placenta, fetal and maternal, 117 
Plants in the sick-room, removal of, 
290 

riasma, blood, 90 
Plaster, cantharidal, 106 
mustard, 106 

removing a, method of, 178 
Plaster of Paris, 350 
Pleura, inflammation of. (See 
Pleurisy .) 

Pleurisy, 243 

position of patient in, 46 
symptoms of, 243 





INDEX. 


449 


Pleurisy, treatment, 243 
Pneumonia, croupous, 240 

symptoms, favorable and unfa¬ 
vorable, 240 
treatment, 240 
“ double,” defined, 240 
Poison defined, 208 
Poisoning, accidental, 208-212 
what to do in case of, 208 
by tainted meats or fish, antidotes, 
212 

carbolic-acid, from absorption, 
symptoms, 169 
from ivy, treatment, 210 
induction of vomiting in, 209 
iodoform, from absorption, symp¬ 
toms, 170 

mercurial, by inunction, symptoms 
of, 79, 169 

septic, from catheterization, 68 
Poisons, classification and action of, 
208 

irritant, 209 
action of, 208 
narcotic, 211 
action of, 208 
Polyarthritis, 259 

Position, change of, by patient, favor¬ 
able sign, 46 

for gynecologic examination, 137 
—dorsal, 137 
—knee-chest, 139 
—Sims, 138 
—upright, 140 
for surgical operation, 148 
Trendelenburg, 148, 149 
Potash, antidotes, 210 
Potassium carbonate, antidotes, 210 
Poultice, the, action of, 91 
boric-acid, 100 
carbolic-acid, 100 
corrosive-sublimate, 100 
creolin, 100 

green soap, in surgical operations, 

renewal of, on sleeping patient, 97 
Poultices, 95-101 

—antiseptic, 100 
—bread, 98 
—bran-jacket, 98. 

—charcoal, 98 
—flaxseed, 95 

29 


Poultices :—green-soap, 100 
—hop, 100 
—ice, 100 
—jacket, 97 
—mustard, 98 
—slippery-elm, 100 
—spice, 99 
—starch, 99 
—yeast, 99 

method of applying, proper, 96 
renewal of, frequency, 96 
Powder, applying, to the throat, 
method of, III 
Powders, administering 74 
Pregnancy: 

—abdominal enlargement, 

rate of, 116 
—conception, 116 
—dale of confinement, 116 
—disorders of, 119 
—duration of, 116 
—fetal movements, 118 
—fetus, the, 117 
—nurse's preparations for the 
confinement, 120 
—signs and symptoms of, 115 
—termination of, 120 
disorders of, 119 
extra-uterine, 136 
Presentations in labor, 122, 123 
Prostration, nervous, 257 
Protrusion, bowel, of infancy, 275 
“ Proud flesh,” 189 
Prussic acid, 346 
antidotes, 209 
Puddings, recipes for, 323 
Puerperium, management of the, 129 
—breast-bandage, 132 
—care of the breasts, 131 
—catheterization, 129 
—lactation, 131 
—the after-pains, 131 
—the diet, 130 
—the lochia, 130 
—the napkins, 130 
—the temperature and pulse, 
13° 

pathology of the, 133-136 
—eclampsia, 135 
—hemorrhages, 133 
—insanity, 135 
—phlegmasia dolens, 135 





INDEX ; 


450 

Paerperium, pathology of the:—septi¬ 
cemia, 134 
—thrombosis, 136 
Pulse, the, 39-41 

“ dicrotic wave ” of, 40 
during the puerperium, 130 
frequency of, 40 
in children, 41 
in croupous pneumonia, 240 
in hemorrhage following surgical 
operation, 161 
in septicemia, 166 
in shock, 160 
in small-pox, 226 
in typhoid fever, 216 
in typhus fever, 225 
in uremia, 250 
of infancy, 277 
taking of the, 40 
varieties of, 40 

—compressible, 40 
—dicrotic, 40 
—frequent, 40 
—full, 40 
—high-tension, 40 
—incompressible, 40 
—intermittent, 40 
—irregular, 40 
—low-tension, 40 
—rapid, 40 
—regular, 40 
—running, 40 
Pulse-rate, 39-41 
at puberty, 41 

conditions influencing the, 39 
influence of body-temperature on, 
42, 43 

in septicemia, 166 
normal, 41 

of infant at birth, 41, 269, 277 
rate of decrease, 277 
of infants and children, 41 
of the aged, 41 

Purgative enemata, administration of, 
61, 62 

formulae for, 62 
Purgatives, administering, 75 
Pyemia, symptoms, 190 
treatment, 190 

Quicksilver, 362 
Quinia, antidotes, 212 


Radius, the, 299 
Rash. (See Eruption.') 

Recipes: 

beef-teas and extracts: 

—beef-essence, 319 
—beef-extract, bottled, 319 
—beef-juice, 319 
—beef-tea, 319, 320 
—beef-tea, peptonized, 320 
—beef-tea with oatmeal, 320 
beverages: 

—chocolate, 333 
—cocoa, 333 
—coffee, 333 
—coffee, crust, 333 
—coffee, nutritious, 334 
—coffee, rice, 334 
—egg-nog, 334 
—lemonade, 334 
—lemonade, egg, 335 
—milk and albumen, 335 
—milk, sterilized, 335 
-milk-punch, 335 
—orangeade, 336 
—sherbert, lemon, 334 
—sherbert, orange, 336 
—tea, 336 
—tea, flaxseed, 336 
—water, albumen-, 336 
—water, apple-, 336 
—water, barley-, 336 
—water, gum-arabic, 337 
—water, rice-, 337 
—water, tamarind-, 337 
—water, toast-, 337 
—wine, mulled, 335 
broths: 

—chicken, 321 
—clam, 321 
—mutton, 321 
—oyster, 323 
desserts: 

—apples, baked, 329 
—cream, Bavarian, 329 
—cream, tapioca, 330 
—cream, whipped, 332 
—Irish moss, 331 
—Irish moss, blanc-mange, 
331 

—jelly, calfs foot, 330 
—jelly, lemon, 330 
—jelly, orange, 330 




Index. 451 


Recipes, desserts :—jelly, peptonized- 
milk, 331 
—jelly, wine, 331 
—junket, 331 
—rice blanc-mange, 329 
-snow-eggs, 332 
—soft custard, 329 
—whey, wine, 332 
farinaceous foods: 

—arrowroot, 317 
—corn-starch, 318 
—gruel, boiled-flour, 318 
—gruel, oatmeal, 318 
—gruel, rice-flour, 318 
—oatmeal, 318 
milk: 

—koumyss, 327 
—peptonized, 327 
—sago, 327 
miscellaneous : 

—chicken panada, 326 
—eggs, poached, 325 
—eggs, scrambled, 326 
—eggs, soft-boiled, 326 
—infant’s food, 326 
—macaroni, 325 
—omelet, 325 
—potatoes, creamed, 325 
oysters: 

—broth, 323 
—fricasseed, 322 
—peptonized, 322 
—stewed, 322 
puddings : 

—arrowroot, 323 
—corn-flour, 323 
—custard, 323 
—rice, 323 
—sago, 323 
—snow, 324 
soups: 

—chicken, 324 
—mutton, 324 
—potato, 324 
—white-celery, 324 
sweetbreads, 321 
toasts: 

—cream toast, 328 
—dry toast, 328 
—egg toast, 328 
—milk toast, 328 
—milk toast, peptonized, 328 


Record, nurse’s, of food taken by 
patient, 46 

of pulse, temperature, and res¬ 
piration, importance of, 45 
of symptoms, 45-52 
Records, nurse’s, keeping the, 25-28 
Rectal douche, 67 
Rectum, the, 308 
gas, passage of, 50 
medicines administered by the, 76 
temperature in, taking the, 44 
Reflex action, 303 
Relapse in typhoid fever, 216 
Reports, nurse’s, essentials of the, 
39 

method of making, 26, 27 
Respiration, 45, 46, 289 

artificial, in the apparently 
drowned, 201, 202 
in shock, 161 
of the new-born, 127 
Cheyne-Stokes, 45 
conditions influencing the, 45 
mechanism of, 289 
normal, 44 
of infancy, 45, 277 
of the new-born, first, 125 
taking the, 44 
Rest for inflammation, 105 

in after-treatment of surgical 
operation, 163 
Rest-cure, 257 

Retention of urine of the new born, 
264 

treatment of, 203 
Rheumatism, 258 
articular, acute, 258 
complications of, 259 
“ monoarticular,” 259 
muscular, acute, 259 
nursing in, 258 
treatment, medicinal, 259 
Ribs, the, 297 

attachment and number, 297, 298 
Rickets, symptoms of, 273 
treatment of, 273 
Ringworm, 260 
Rochelle salt, 364 
enema of, 62 

Roller-bandages, 178-183 
Room disinfection by corrosive-sub¬ 
limate solution, 235 



452 INDEX. 


Room temperature for rheumatic 
patients, 258 
regulation of, 37 
Room-ventilation, 37 

in scarlet-fever cases, 223 
Rubefacients, 104 

Sacrum, 298 

St. Vitus’ dance. (See Chorea .) 
Saliva, digestive action of, 292 
Salt enema, 63 
-solution, 162 

Sand-bags, how made, 174 
Sartorius, 299 
Scabies, 259 

Scalds. (See Burns and Scalds .) 
Scapula, the, 298 
Scarlatina. (See Scarlet fever.) 
Scarlet fever, 222-225 
complications of: 

—dropsy, 224 
—nephritis, 224 
—uremia, 224 
convalescence of, 225 
delirium of, 225 
depression in, 225 
disinfection in, 223 
malignant, 222 
room-ventilation in, 223 
symptoms of, 222 
treatment of, 222 
uremic convulsions of, treatment, 
224 

Scarlet-fever tongue, 47 
Screen, bed-, improvised, 34 
Sea-bathing, 82 
Secretions, body, 292 
Sedatives, action of, 72 
Sepsis after childbirth, symptoms, 131 
death from, responsibility for, 166 
Septicemia, 165 
puerperal, 134 
symptoms, 166 
treatment, 166, 167 
Serpent-bites, treatment, 212 
Sheet-bath (drip-sheet), 87 
Sheets, bed-, changing of, without 
removing the patient, 30, 31 
Shingles, 260 

Shock, body-temperature in, 160 
conditions influencing, 160 
enemata in, 160 


Shock, from burns, 198 

from surgical operation, 159 
respiration, artificial, in, 161 
symptoms, 160 
treatment, 160 
Shoulder-blade, 298 
“ Show,” the, 124 
Shower-bath, 86 

Sick, feeding the, general rules for, 

serving the food in, 311 
Sick-room, the, 29-38 
air of the, 37 
cooling the, 37 

bearing of the nurse in, 18-23 
bed, preparation of, 29 
care of the, 36 
dress of the nurse in the, 25 
etiquette of the, 24 
fumigation of the, after contagious 
diseases, 234-236 
keeping the records, methods of, 
25-27 

plants in the, removal of, 290 
preparation of, 29 
removal of excreta from, 38 
selection of, 29 
temperature of, 36 
regulation of, 37 
ventilation of, 37, 38, 223 

protection of patient during, 38 
Sigmoid flexure, 307 
Sign of labor, first, 123 
Signs of pregnancy, positive, 116 
probable, 115 
“vital,” the three, 39 
Sinus, 192 

Sitz-bath, action of, 82 
Skin, anatomy of the, 296 
color of, cause of, 296 
diseases of the: 

—eczema, 259 
-—herpes zoster, 260 
—ringworm, 260 
—scabies, 259 
treatment of, 260 
of the patient, color of, 49 
condition of, 49 

redness of, inflammatory, cause of, 

91 

Skin-grafting, 200 
Skull, bones of the, 297 




INDEX. 


453 


Sleep, taking of, by the nurse, 21 
Sleeplessness, treatment of, 206 
Small-pox, 226-228 
confluent, 227 
malignant, 227 
nursing-treatment, 227, 228 
pitting of, prevention, 228 
symptoms, 226 

Smoke, escaping through, how to 
prevent suffocation in, 203 
Snuffles of infancy, 276 
Soda, antidotes, 210 
Sodium carbonate, antidotes, 210 
Solutions, antiseptic, 341 
Soups, recipes for, 324 
Spanish flies, 351 
Spanish-fly blister, 106-108 
Spinal column, 298 
cord, 301 
Spleen, the, 307 
Splint, coaptation, 186 

improvised, in fracture, 173 
plaster-of-Paris, 186 
how to remove, 187 
Splints, 186, 187 
Sponge-bath, 55 
Sponges, gauze, 147 
sterilizing the, 172 
surgical, attention required of the 
nurse in handling, 157, 
158 

Sprains, treatment, 176 
Sprays, 11 o 

Sputum, disposition of, in infectious 
diseases, 48 

Sputum-cup, 48, 236, 241 
Stages of normal labor, 123-125 
—first stage, 123 
—second stage, 124 
—third stage, 125 
Stapedius, 299 
Stapes, 297 

Starch-and-laudanum enema, 62 
Steam-bath, acid, action of, 86 
Sterilization by boiling water, 152 
for surgical operations, 147 
milk, 266 

of foods. (See Recipes.) 
of gauze sponges, 172 
of nurse’s hands, importance of, 
156, 221. 

of suture-materials, 171 


Sterilization of utensils, etc. used for 
surgical operations, 157, 
17 1 , 172 

personal, of nurse, for surgical 
operation, 156, 157 
surgical, 147, 151, 152 
.Sterilized milk, 335 
Sternum, 298 
Stimulants, action of, 72 

alcoholic, in treatment of hemor¬ 
rhage, 194 

per rectum, effect of, 64 
Stimulating enemata, 63 
Stomach, the, 290, 305 
bleeding from the, 196 
food-changes in the, 292 
inflammation of. (See Gastritis.) 
washing out the, 70 
“ Strawberry-tongue,” 47, 222 
Stretcher, improvised bed-room, 59 
Strychnia, antidotes, 211 
as a heart-stimulant, 161 
Stupes. (See Fomentations.) 
Subinvolution of womb, 126 
Suffocation from drowning, treat¬ 
ment, 201 

Sugar in the urine, Trammers’ test 
for, 295 
Sugar-water, 267 
Sulphuric acid, antidotes, 210 
Sunburn, treatment, 206 
Sunstroke, 200 

body-temperature in, 42, 200 
symptoms, 200 
treatment, 200 

Suppositories, introduction of, 76 
Suppuration, 189 
Suture, button, 171 
continuous, 171 
interrupted, 171 
Sutures, materials of, 171 
sterilizing of, 171 
Suturing, 171 

Swallowing, involuntary, how to in¬ 
duce, 252 

Sweeping and dusting the sick-room, 

3 6 

Sweetbreads, cooking of, 321 
Sweet oil, 363 

spirits of nitre, 355 
Swelling, inflammatory, cause of, 91 
Symptoms, observation of, 45— 5 2 



454 


INDEX. 


Synovial fluid, 297 
Syringe, fountain, uses of, 25 

hard-rubber, to prevent leakage of, 
60 

hypodermic, care of the, 78 
method of using the, 77 
Syringing the eyes of infants, method 
of, 275 > 

Table, gynecologic, 141 
Table salt, 366 

Tablets, hypodermatic, list of, 342 
Tampon, kite-tail, 144 
Tampons, vaginal, 143 
Tartar emetic, 348 
Tartaric acid, antidotes, 209 
Tears, age when infant first sheds, 268 
Tear-secretion, 112 
Teeth, age when growth of the, be¬ 
gins, 268 

development of the, 268 
Teething of infancy, 274 
Temperature, body-, 41-44 

after childbirth, rise of, 131 
conditions influencing increase 
of, 41 

during the puerperium, 131 
in bronchitis, 242 
in cerebro-spinal meningitis, 251 
in croupous pneumonia, 240 
in diphtheria, 229 
in hemorrhage, 160, 161 
in measles, 228 
in peritonitis, 245 
in rheumatism, 258 
in scarlet fever, 222 
in septicemia, 166 
in shock, 160 
in small-pox, 226, 227 
in sunstroke, 200 
in tetanus, 42 
in typhoid fever, 215 
in typhus fever, 225 
of infant at birth, 269 
of infants, how to take the, 276 
subnormal, causes of, 42 
taking of the, 43 
sick-room, 36 
regulation of, 37 
Tendo Achillis, 300 
Tendons, 300 
Tents (surgical), 177 


Tepid bath, action of, 82 
Tetanus, 190 

body-temperature in, 42 
symptoms, 190 
treatment, 190 
Thermometer, bath-, 81 
clinical, the, 43 
Thigh-bone. (See Femur.} 

Thirst in hemorrhage, 196 
relief of, by bathing, 82 
after operation, 163 
in typhoid fever, relief of, 218 
Thorax, 297 

Throat, gargling and spraying the, 
IIO, in 

precautions in, in 
obstruction in the, removal of, 
205 

sore, hot-water gargling in, in 
Thrombosis, 136 
Thrush, treatment, 270 
Tibia, the, 299 
Toasts, recipes for, 328 
Toilet of the patient, 53-56 
—bath, the, 55 
—bed-pan, the, 56 
—care of the body, 54 
—cleansing the mouth, 53 
—dressing the hair, 53 
Tongue, appearance of, in scarlet 
fever, 222 

coated, in fevers; 46, 47 
infant’s, how to see the, 276 
“ strawberry,” 47, 222 
Tongue-tie, 276 
Tongue-trembling, 47 
Tonics, action of, 72 
Toothache, treatment of, 206 
Tourniquet, 195 
Trachea, the, 305 
Tracheotomy, after-care in, 232 
in diphtheria, 231 

duties of the nurse, 231 
in scalds of the glottis, 198 
Tracheotomy-tube, care of the, 232, 
.233 

Transfusion, 162 

Trendelenburg: position, 148, 14Q 
Tub-bath, 55,'S3 
Tubes, bronchial, 305 
Fallopian, 309 
Turpentine enema, 62 




INDEX. 


Tympanites in typhoid cases, relief 
of, 221 

Tympanum, the, 304 
Typhoid fever, 215 

bed-sores in, prevention of, 221 
body-temperature of, 215 
excreta of, disinfection of, 216 
coating of, tongue in, 46, 47 
complications of, 219 

—hemorrhage, 219, 220 
—perforation, 220 
convalescence, management of, 
221 

diet in, 217, 218 
nursing in, 216 
of children, 278 
treatment, 278 
period of incubation, 215 
relapse in, 216 
symptoms, 215 
synonyms of, 215 
tepid baths in, 219 
the eruptions in, 216 
thirst in, relief of, 218 
treatment of, 217-222 
tympanites of, relief of, 221 
walking, 221 
Typhus fever, 225 
complications of, 226 
symptoms, 225 
treatment, 226 

Ulcer, 192 
Ulna, the, 299 

Union of broken bones, process of, 
173 

Uremia, 250 

complicating scarlet fever, 224 
symptoms, 250 
treatment, 250 
Ureters, the, 308 
Urethra, the, 308 
Urinalysis, 295 
Urination of infant, 264 
Urine, the, 293 

abnormalities of the, 51 
albumin in the, 294 
test for, 295 

amount of, conditions affecting the, 

293 . 294 

in diabetes mellitus, 293 
color of, 293, 294 


455 

Urine, color of, conditions affecting, 
294 

composition of, 293 
excretion of, in pleurisy, 243 
incontinence of, 50, 119 
in children, 279 
in diabetes, 258 
odor of, 293, 294 
of the patient, condition of, 50 
of the pregnant, attention to, 119 
passage of, 50, 51 

points to be noted, 51 
quantity of, normal, 293 
reaction of, 293 

method of determining, 294 
retention of, by the new-born, re¬ 
lief of, 265 
danger of, 308 
in typhoid fever, 217 
treatment of, 203 
specific gravity, 293 

method of ascertaining, 294 
sugar or urea in, 294 
test for, 295 

suppression of, from cantharidism, 
107 

testing the, 295 
Urinometer, 294 
Uterus, the, 308 

Vaginal douche,administration of ,66 
apparatus for, 65 
purpose and effect of, 66 , 67 
Valve, mitral, 287 
tricuspid, 287 
Valves, heart, 287 
semilunar, 287 
Vapor-baths, action of, 81,83 
Varioloid, 227 
Vein, jugular, 300 
Veins, the, 286 
hepatic, 289 
pulmonary, 287 
“ Vena portae,” 288 
Ventilation, sick-room, 37, 223 
Ventilator, window, 38 
Ventricles, heart, 287 
Vermiform appendix, 307 
Vermin, head, extermination of, 53 
Vernix caseosa, 262 
Vertebrae, 298 
cervical, 298 







456 


INDEX. 


Vertebrae, dorsal, 298 
lumbar, 298 
Vesication, 105 
Vestibule (ear), 305 
“ Vital signs,” the three, 39 
Vomiting, induction of, in poisoning, 
209 

in ether anesthesia, 154 
in septicemia, 166 
treatment of, 167 
of infancy, 272 
of patient, symptoms of, 46 
repetition of dose after, 76 
treatment of, 206 

Wafers, medicine, 74 
Warm bath, action of, 81, 82 
Water-bed, 33 

Water-dressing (surgical), 176, 177 
Waters, mineral, alkaline, 337 
carbonic acid, 338 
chalybeate, 338 
purgative, 338 
saline, 339 
sulphuretted, 339 
Weaning infant, time for, 268 
Weights and measures, 340 


Wharton’s jelly, 118 
Whispering in the sick-room, 24 
Whooping-cough, 238 
complications of, 239 
symptoms, 238 
treatment, 239 
Witch-hazel, 358 
Womb, the, 308 

involution and subinvolution of, 
125, 126 
Wood-oil, 349 
Worms of infancy, 274 
Wound, contused, 188 
defined, 188 
gunshot, 188 
incised, 188 
lacerated, 188 

nurse’s preparation of a, for the 
surgeon, 177 
poisoned, 188 
punctured, 188 
Wounds, 188-191 

aseptic and septic, 188 
dangerous sequelae of, 1S9-191 
healing of, 188 
suppuration of, 189 
varieties of, 188 




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*American Text-Book of Applied Thera¬ 


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*Keating’s Pronouncing Dictionary of 

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PAGE 


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Stengel’s Manual of Pathology.20 

Stevens’ Materia Medica and Therapeutics 12 

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In every instance the latest revised edition is sent. 

In ordering, be careful to state the style of binding desired— 
Cloth, Sheep, Half-Morocco, or Half-Russia. 

A complete descriptive circular, giving table of contents, etc. 
of any book sold by subscription only, will be sent free on 
application. A general catalogue, containing prices and titles 
of the principal medical books published throughout the 
world, will be sent on receipt of a two-cent stamp. 



For Sale by Subscription 


AN AMERICAN TEXT-BOOK OF SURGERY. Edited by Wil¬ 
liam W. Keen, M. D., LL.D., and J. William White, M. D., Ph. D. 
Forming one handsome royal-octavo volume of 1250 pages (10 x 7 inches), 
with 500 wood-cuts in text, and 37 colored and half-tone plates, many of 
them engraved from original photographs and drawings furnished by the 
authors. Prices: Cloth, $7.00 net; Sheep or Half-Morocco, $8.00 net. 


SECOND EDITION, REVISED AND ENLARGED. 


The want of a text-book which could be used by the practitioner and at the 
same time be recommended to the medical student has been deeply felt, espe¬ 
cially by teachers of surgery; hence, when it was suggested to a num6er of 
these that it would be well to unite in preparing a text-book of this description, 
great unanimity of opinion was found to exist, and the gentlemen below named 
gladly consented to join in its production. While there is no distinctive Amer¬ 
ican Surgery, yet America has contributed very largely to the progress of modern 
surgery, and among the foremost of those who have aided in developing this art 
and science will be found the authors of the present volume. All of them are 
teachers of surgery in leading medical schools and hospitals in the United States 
and Canada. 

Especial prominence has been given to Surgical Bacteriology, a feature which 
is believed to be unique in a surgical text-book in the English language. Asep¬ 
sis and Antisepsis have received particular attention. The text is brought well 
up to date in such important branches as cerebral, spinal, intestinal, and pelvic 
surgery, the most important and newest operations in these departments being 
described and illustrated. 

The text of the entire book has been submitted to all the authors for their 
mutual criticism and revision—an idea in book-making that is entirely new and 
original. The book as a whole, therefore, expresses on all the important sur¬ 
gical topics of the day the consensus of opinion of the eminent surgeons who 
have joined in its preparation. 

One of the most attractive features of the book is its illustrations. Very 
many of them are original and faithful reproductions of photographs taken 
directly from patients or from specimens, and the modern improvements in the 
art of engraving have enabled the publisher to produce illustrations which it is 
believed are superior to those in any similar work. 


CONTRIBUTORS: 


Dr. Charles H. Burnett, Philadelphia. 
Phineas S. Conner, Cincinnati. 
Frederic S. Dennis, New York. 
William W. Keen, Philadelphia. 
Charles B. Nancrede, Ann Arbor, Mich. 
Roswell Park, Buffalo, N. Y. 

Lewis S. Pilcher, New York. 


Dr. Nicholas Senn, Chicago. 

Francis J. Shepherd, Montreal, Canada. 
Lewis A. Stimson, New York. 

William Thomson, Philadelphia. 

J. Collins Warren, Boston. 

J. William White, Philadelphia. 


“ If this text-book is a fair reflex of the present position of American surgery, we must 
admit it is of a very high order of merit, and that English surgeons will have to look very 
carefully to their laurels if they are to preserve a position in the van of surgical practice.”— 
London Lancet. 




4 


W. B. SAUNDERS' 


For Sale by Subscription. 


AN AMERICAN TEXT-BOOK ON THE THEORY AND 
PRACTICE OF MEDICINE. By American Teachers. Edited 
by William Pepper, M. D., LL.D., Provost and Professor of the Theory 
and Practice of Medicine and of Clinical Medicine in the University of 
Pennsylvania. Complete in two handsome royal-octavo volumes of about 
iooo pages each, with illustrations to elucidate the text wherever necessary. 
Price per Volume: Cloth, $5.00 net; Sheep or Half-Morocco, 36.00 net. 


VOLUME I. COVTAIXS: 


Hygiene.—Fevers (Ephemeral, Simple Con¬ 
tinued, Typhus, Typhoid, Epidemic Cerebro¬ 
spinal Meningitis, and Relapsing).—Scarla¬ 
tina, Measles, Rotheln, Variola, Varioloid, 
Vaccinia,Varicella, Mumps,Whooping-cough, 
Anthrax, Hydrophobia, Trichinosis, Actino¬ 


mycosis, Glanders, and Tetanus.—Tubercu¬ 
losis, Scrofula, Syphilis. Diphtheria, Erysipe¬ 
las, Malaria, Cholera, and Yellow Fever.— 
Nervous, Muscular, and Mental Diseases etc. 


VOLUME II. CONTAINS: 

Urine (Chemistry and Microscopy).—Kid- ' —Peritoneum, Liver,and Pancreas.—Diathet- 
ney and Lungs.—Air-passages (Larynx and ic Diseases (Rheumatism, Rheumatoid Ar- 
Bronchi) and Pleura.—Pharynx. (Esophagus, thritis. Gout, Lithaemia, and Diabetes.)— 
Stomach and Intestines (including Intestinal Blood and Spleen.—Inflammation, Embolism, 
Parasites), Heart, Aorta, Arteries and Veins, j Thrombosis, Fever, and Bacteriology. 

The articles are not written as though addressed to students in lectures, but 
are exhaustive descriptions of diseases, with the newest facts as regards Causa¬ 
tion, Symptomatology, Diagnosis, Prognosis, and Treatment, including a large 
number of approved formulae. The recent advances made in the study 
of the bacterial origin of various diseases are fully described, as well as the 
bearing of the knowledge so gained upon prevention and cure. The subjects 
of Bacteriology as a whole and of Immunity are fully considered in a separate 
section. 

Methods of diagnosis are given the most minute and careful attention, thus 
enabling the reader to learn the very latest methods of investigation without 
consulting works specially devoted to the subject. 


CONTRIBUTORS: 


Dr. J. S. Billings, Philadelphia. 
Francis Delafield, New York. 
Reginald H. Fitz, Boston. 

James W. Holland, Philadelphia. 
Henry M. Lyman, Chicago. 
William Osier, Baltimore. 


Dr. William Pepper, Philadelphia. 

W. Gilman Thompson, New York. 
W. H. Welch, Baltimore. 

James T. Whittaker, Cincinnati. 
James C. Wilson, Philadelphia. 
Horatio C. Wood, Philadelphia. 


" We reviewed the first volume of this work, and said: ‘ It is undoubtedly one of the best 
text-books on the practice of medicine which we possess.’ A consideration of the second 
and last volume leads us to modify that verdict and to say that the completed work is, in our 
opinion, the best of its kind it has ever been our fortune to see. It is complete, thorough, 
accurate, and clear. It is well written, well arranged, well printed, well illustrated, and well 
bound. It is a model of what the modern text-book should be .”—Nnv York Medical Journal. 

“ A library upon modern medical art. The work must promote the wider diffusion of 
sound knowledge .”—American Lancet. 

“ A trusty counsellor for the practitioner or senior student, on which he may implicitly 
rely .”—Edinburgh Medical Journal. 






CATALOGUE OF MEDICAL WORKS. 


5 


For Sale by Subscrijition. 


AN AMERICAN TEXT-BOOK OF THE DISEASES OF CHIL¬ 
DREN. By American Teachers. Edited by Louis Starr, M. D., 
assisted by Thompson S. Westcott, M. D. In one handsome royal-8vo 
volume of 1190 pages, profusely illustrated with wood-cuts, half-tone and 
colored plates. Net Prices : Cloth, $7.00; Sheep or Iialf-Morocco, $8.00. 


The plan of this work embraces a series of original articles written by some 
sixty well-known podiatrists, representing collectively the teachings of the most 
prominent medical schools and colleges of America. The work is intended to 
be a practical book, suitable for constant and handy reference by the practi¬ 
tioner and the advanced student. 

One decided innovation is the large number of authors, nearly every article 
being contributed by a specialist in the line on which he writes. This, while 
entailing considerable labor upon the editors, has resulted in the publication of 
a work thoroughly new and abreast of the times. 

Especial attention has been given to the latest accepted teachings upon the 
etiology, symptoms, pathology, diagnosis, and treatment of the disorders of chil¬ 
dren, with the introduction of many special formulae and therapeutic procedures. 

Special chapters embrace at unusual length the Diseases of the Eye, Ear, 
Nose and Throat, and the Skin; while the introductory chapters cover fully the 
important subjects of Diet, Hygiene, Exercise, Bathing, and the Chemistry of 
Food. Tracheotomy, Intubation, Circumcision, and such minor surgical pro¬ 
cedures coming within the province of the medical practitioner are carefully 
considered. 

CONTRIBUTORS: 


Dr. S. S. Adams, Washington. 

John Ashhurst, Jr., Philadelphia. 

A. D. Blackader, Montreal, Canada. 
Dillon Brown, New York. 

Edward M. Buckingham, Boston. 
Charles W. Burr, Philadelphia. 

W. E. Casselberry, Chicago. 

Henry Dwight Chapin, New York. 
W. S. Christopher, Chicago. 
Archibald Church, Chicago. 

Floyd M. Crandall, New York. 
Andrew F. Currier, New York. 
Roland G. Curtin, Philadelphia 
. M. DaCosta, Philadelphia. 

. N. Danforth, Chicago. 

Edward P. Davis, Philadelphia. 
John B. Deaver, Philadelphia. 

G. E. de Schweinitz, Philadelphia. 
John Doming, New York. 

Charles Warrington Earle, Chicago. 
Wm. A. Edwards, San Diego, Cal. 
F. Forchheimer, Cincinnati. 

J. Henry Fruitnight, New York. 
Landon Carter Gray, New York. 

J. P. Crozer Griffith, Philadelphia. 
W. A. Hardaway. St. Louis. 

M. P Hatfield, Chicago. 

Barton Cooke Hirst, Philadelphia. 

H. Illoway, Cincinnati. 

Henry Jackson, Boston. 

Charles G. Jennings, Detroit. 

Henry Koplik, New York. 


I Dr. Thomas S. Latimer, Baltimore. 

Albert R. Leeds, Hoboken, N. J. 

J. Hendrie Lloyd, Philadelphia. 

George Roe Lockwood, New York. 
Henry M. Lyman, Chicago. 

Francis T. Miles, Baltimore. 

Charles K. Mills, Philadelphia. 

John H. Musser, Philadelphia. 

Thomas R. Neilson, Philadelphia. 

W. P. Northrup, New York. 

William Osier, Baltimore. 

Frederick A. Packard, Philadelphia. 
William Pepper, Philadelphia. 
Frederick Peterson, New York. 

W. T. Plant, Syracuse, New York. 
William M. Powell, Atlantic City. 

B. Alexander Randall, Philadelphia. 
Edward O. Shakespeare, Philadelphia. 
F. C. Shattuck, Boston. 

J. Lewis Smith, New York. 

Louis Starr, Philadelphia. 

M. Allen Starr, New York. 

J. Madison Taylor, Philadelphia. 
Charles W. Townsend, Boston. 

James Tyson, Philadelphia. 

W. S. Thayer, Baltimore. 

Victor C. Vaughan, Ann Arbor, Mich 
Thompson S. Westcott, Philadelphia. 
Henry R. Wharton, Philadelphia. 

J. William White, Philadelphia. 

J. C. Wilson, Philadelphia. 







6 


W. B. SAUNDERS' 


For Sale by Subscription. 


AN AMERICAN TEXT-BOOK OF GYNECOLOGY, MEDICAL 
AND SURGICAL, for the use of Students and Practitioners. 

Edited by J. M. Baldy, M. D. Forming a handsome royal-octavo volume, 
with 360 illustrations in text and 37 colored and half-tone plates. Prices: 
Cloth, $6.00 net; Sheep or Half-Morocco, #7.00 net. 

In this volume all anatomical descriptions, excepting those essential to a clear 
understanding of the text, have been omitted, the illustrations being largely de¬ 
pended upon to elucidate the anatomy of the parts. This work, which is 
thoroughly practical in its teachings, is intended, as its title implies, to be a 
working text-book for physicians and students. A clear line of treatment has 
been laid down in every case, and although no attempt has been made to dis¬ 
cuss mooted points, still the most important of these have been noted and ex¬ 
plained. The operations recommended are fully illustrated, so that the reader, 
having a picture of the procedure described in the text under his eye, cannot fail 
to grasp the idea. All extraneous matter and discussions have been carefully 
excluded, the attempt being made to allow no unnecessary details to cumber 
the text. The subject-matter is brought up to date at every point, and the 
work is as nearly as possible the combined opinions of the ten specialists who 
figure as the authors. 

The work is well illustrated throughout with wood-cuts, half-tone and 
colored plates, mostly selected from the authors’ private collections. 


CONTRIBUTORS: 


Dr. Henry T. Byford. 


Dr. Howard A. Kelly. 
Florian Krug. 



E. E. Montgomery 
William R. Pryor. 
George M. Tuttle. 


William Goodell. 


“The most notable contribution to gynecological literature since 1887, .... and the most 
complete exponent of gynecology which we have. No subject seems to have been neglected, 
.... and the gynecologist and surgeon, and the general practitioner who has any desire 
to practise diseases of women, will find it of practical value. In the matter of illustrations 
and plates the book surpasses anything we have seen.”— Boston Medical and Surgical 
Journal. 

“A valuable addition to the literature of Gynecology. The writers are progressive, 
aggressive, and earnest in their convictions.”— Medical News, Philadelphia. 

“ A thoroughly modern text-book, and gives reliable and well-tempered advice and in¬ 
struction.”— Edinburgh Medical Journal. 

“ The harmony of its conclusions and the homogeneity of its style give it an individuality 
which suggests a single rather than a multiple authorship.”— Annals of Surgery. 

“ It must command attention and respect as a worthy representation of our advanced 
clinical teaching.”— American Journal of Medical Sciences. 






CATALOGUE OF MEDICAL WORKS. 


7 


For Sale by Subscription. 


AN AMERICAN TEXT-BOOK OF OBSTETRICS. By American 
Teachers. Richard C. Norris, A. M., M. D., Editor; Robert L. 
Dickinson, M. D., Art Editor. Contributors: James H. Etheridge, 
M. D.; Chauncey D. Palmer, M. D.; Howard A. Kelly, M.D.; Charles 
Jewett, M. D.; Henry J. Garrigues, M. D.; Barton Cooke Hirst, M.D.; 
Theophilus Parvin, M. D.; George A. Piersol, M. D.; Edward P. Davis, 
M. D.; Charles Warrington Earle, M. D.; Robert L. Dickinson, M. D.; 
Edward Reynolds, M. D.; Henry Schwarz, M. D.; and James C. Cam¬ 
eron, M.D. In one very handsome imperial-octavo volume, with nearly 900 
illustrations, including full-page plates, and uniform with “ An American 
Text-Book of Gynecology.” Prices: Cloth, $7.00 net; Sheep or Half- 
Morocco, $8.00 net. 

Such an array of well-known teachers is a sufficient guarantee of the high 
character of the work, and it gives the assurance that this work will have the 
same measure of success awarded it as attended the recent publication of its 
companion volume, “ An American Text-Book of Gynecology.” 

While the writers have each been assigned special themes for discussion, the 
correlation of the subject-matter is, nevertheless, such as ensures logical connec¬ 
tion in treatment, the deductions of which thoroughly represent the latest 
advances in the science and elucidate the best modern methods of procedure. 

The illustrations have received the most minute attention; the cuts interspersed 
throughout the text, and the full-page plates, reflect the highest attainments of 
the artist and engraver, and appeal at once to the eye as well as to the mind of 
the student and practitioner. 


AN AMERICAN TEXT-BOOK OF APPLIED THERAPEUTICS. 

By American Teachers. Edited by J. C. Wilson, M. D., Professor of 
the Practice of Medicine and of Clinical Medicine in the Jefferson Medical 
College, Philadelphia. (Nearly Ready.) 


AN AMERICAN TEXT-BOOK OF PHYSIOLOGY. By American 

Teachers. Edited by William H. Howell, Ph. D., M. D., Professor 
of Physiology, Johns Hopkins University. (In preparation for early pub¬ 
lication.) 

AN AMERICAN TEXT-BOOK OF NURSING. By American 
Teachers. (In preparation.) 







8 


IV. B. SAUNDERS' 


For Sale by Subscription. 

A NEW PRONOUNCING DICTIONARY OF MEDICINE, with 
Phonetic Pronunciation, Accentuation, Etymology, etc. By John 

M. Keating, M. D., LL.D., Fellow of the College of Physicians of Phila¬ 
delphia; Vice-President of the American Paediatric Society; Ex-President 
of the Association of Life Insurance Medical Directors; Editor “ Cyclo¬ 
paedia of the Diseases of Children,” etc.; and Henry Hamilton, author 
of “A New Translation of Virgil’s Hineid into English Rhyme;” co¬ 
author of “ Saunders’ Medical Lexicon,” etc.; with the Collaboration of 
J. Chalmers DaCosta, M. D., and Frederick A. Packard, M. D. 
With an Appendix containing important Tables of Bacilli, Micrococci, 
Leucomaines, Ptoma'ines, Drugs and Materials used in Antiseptic Sur¬ 
gery, Poisons and their Antidotes, Weights and Measures, Thermometric 
Scales, New Official and Unofficial Drugs, etc. One very attractive volume 
of over 800 pages. Second Revised Edition. Prices: Cloth, $5.00 net; 
Sheep, $6.00 net; Half-Russia, $6.50 net, with Denison’s Patent Ready- 
Reference Index; without patent index, Cloth, $4.00 net; Sheep, $5.00 net. 
PROFESSIONAL OPINIONS. 

“ I am much pleased with Keating’s Dictionary, and shall take pleasure in recommending 
it to my classes.” 

Henry M. Lyman, M. D., 

Professor of Principles and Practice of Medicine, Rush Medical College, Chicago, III. 

“ I am convinced that it will be a very valuable adjunct to my study-table, convenient in 
size and sufficiently full for ordinary use.” 

C. A. Lindsley, M. D., 

Professor of Theory and Practice of Medicine, Medical Dept. Yale University ; 

Secretary Connecticut State Board of Health, New Haven, Conn , 

“ I will point out to my classes the many good features of this book as compared with 
others, which will, I am sure, make it very popular with students.” 

John Cronyn, M. D., LL.D., 

Professor of Principles and Practice of Medicine and Clinical Medicine; 

President of the Faculty, Medical Dept. Niagara University, Buffalo, N. Y. 


AUTOBIOGRAPHY OF SAMUEL D. GROSS. M. D., Emeritus Pro¬ 
fessor of Surgery in the Jefferson Medical College of Philadelphia, with 
Reminiscences of His Times and Contemporaries. Edited by his sons, 
Samuel W. Gross, M. D., LL.D., late Professor of Principles of Surgery 
and of Clinical Surgery in the Jefferson Medical College, and A. Haller 
Gross, A. M., of the Philadelphia Bar. Preceded by a Memoir of Dr. 
Gross, by the late Austin I’lint, M. D., LL.D. In two handsome volumes, 
each containing over 400 pages, demy 8vo, extra cloth, gilt tops, with fine 
Frontispiece engraved on steel. Price, $5.00 net. 

This autobiography, which was continued by the late eminent surgeon until 
within thiee months of his death, contains a full and accurate history of his 
eaily struggles, trials, and subsequent successes, told in a singularly interesting 
and charming manner, and embraces short and graphic pen-portraits of many 
of the most distinguished men—surgeons, physicians, divines, lawyers, states¬ 
men, scientists, etc.—with whom he was brought in contact in America and in 
Euiope; the whole forming a retrospect of more than three-quarters of a century. 








CATALOGUE OF MEDICAL WO EES. 


9 


For Sale by Subscription. 


SURGICAL PATHOLOGY AND THERAPEUTICS. By J. Col¬ 
lins Warren, M. D., LL.D., Professor of Surgery, Harvard Medical 
School, etc. One handsome octavo volume of 832 pages, with 136 illus¬ 
trations, 33 of which are chromo-lithographs, and all of which were drawn 
from original specimens. Prices: Cloth, $6.00 net; Plalf-Morocco, $7.00 net. 

Covering as it does the entire field of Surgical Pathology and Surgical Thera¬ 
peutics by an acknowledged authority, the publisher is confident that the work 
will rank as a standard authority on the subject of which it treats. Particular 
attention has been paid to Bacteriology and Surgical Bacteria from the stand¬ 
point of recent investigations. The chromo-lithographic plates in their fidelity to 
nature and in scientific accuracy are incomparable. 

PATHOLOGY AND SURGICAL TREATMENT OF TUMORS. 

By N. Senn, M. D., Ph. D., LL. D., Professor of Practice of Surgery and 
of Clinical Surgery, Rush Medical College; Professor of Surgery, Chicago 
Polyclinic; Attending Surgeon to Presbyterian Hospital; Surgeon-in-Chief, 
St. Joseph’s Hospital, Chicago. One volume of 710 pages, with 515 
engravings, including full-page colored plates. Prices: Cloth, $6.00 net; 
Half-Morocco, $7.00 net. 

This work epitomizes the results of many years of personal observation and 
successful experience of its author, whose professional eminence guarantees the 
authoritative character of the subject-matter. The illustrations are profuse and 
unusually fine, including more than 100 original photographic reproductions of 
the microscopic appearances of a great variety of morbid conditions. 

MEDICAL DIAGNOSIS. By Dr. Oswald Vierordt, Professor of 
Medicine at the University of Heidelberg. Translated, with additions, 
from the Second Enlarged German Edition, with the author’s permission, 
by Francis H. Stuart, A. M., M. D. Third and Revised Edition. In 
one handsome royal-octavo volume of 700 pages, 178 fine wood-cuts in 
text, many of which are in colors. Prices : Cloth, $ 4 -°° ne G Sheep, $5^0 
net; Half Russia, $5.50 net. 

In this work, as in no other hitherto published, are given full and accurate 
explanations of the phenomena observed at the bedside. It is distinctly a clin¬ 
ical work by a master teacher, characterized by thoroughness, fulness, and accu¬ 
racy. It is a mine of information upon the points that are so often passed over 
without explanation. Especial attention has been given to the germ-theory as 

a factor in the origin of disease. , 

This valuable work is now published in German, English, Russian, and 
Italian. The issue of a third American edition within two years indicates the 
favor with which it has been received by the profession. 






10 


W. B. SAUNDERS' 


For Sale by Subscription. 


DISEASES OF THE EYE. A Handbook of Ophthalmic Practice. 

By G. E. de Schweinitz, M. D., Professor of Diseases of the Eye, Phila¬ 
delphia Polyclinic; Professor of Clinical Ophthalmology, Jefferson Medical 
College, Philadelphia, etc. A handsome royal-octavo volume of nearly 700 
pages, with 256 fine illustrations, many of which are original, and 2 chromo- 
lithographic plates. Prices: Cloth, $4.00 net; .Sheep, $5.00 net; Half- 
Russia, $5.50 net. 


SECOND EDITION, REVISED AND ENLARGED. 

The object of this work is to present to the student and practitioner who is 
beginning work in the fields of ophthalmology a plain description of the optical 
defects and diseases of the eye. To this end special attention has been paid 
to the clinical side of the question; and the method of examination, the symp¬ 
tomatology leading to a diagnosis, and the treatment of the various ocular defects 
have been brought into special prominence. The general plan of the book is 
eminently practical. Attention is called to the large number of illustrations 
(nearly one-third of which are new), which will materially facilitate the thorough 
understanding of the subject. 

“At once comprehensive and thoroughly up to date.”— Hospital Gazette (London). 


PROFESSIONAL OPINIONS. 

“Contains in concise and reliable form the accepted views of Ophthalmic Science.” 

William Thomson, M. D., 

Professor of Ophthalmology, yefferson Medical College, Philadelphia, Pa. 


“ A very reliable guide to the study of eye diseases, presenting the latest facts and newest 
*^ eas - Swan M. Burnett, M. D., 

Professor of Ophthalmology and Otology, Medical Department Univ. of Georgetown , 

Washington, D. C. 


THE PICTORIAL ATLAS OF SKIN DISEASES AND SYPHI¬ 
LITIC AFFECTIONS. (American Edition.) Translation from 
the French. Edited by J. J. Pringle, M. B., F. R. C. P., Assistant Phy¬ 
sician to, and Physician to the department for Diseases of the Skin at, the 
Middlesex Hospital, London. Photo-lithochromes from the famous models 
of dermatological and syphilitic cases in the Museum of the Saint-Louis 
Hospital, Paris, with explanatory wood-cuts and letter-press. In 12 Parts, 
at $3.00 per Part. Parts I to 3 now ready. 

“The plates are beautifully executed.”— Jonathan Hutchinson, M. D. (London 
Hospital). 

“The plates in this Atlas are remarkably accurate and artistic reproductions of typical 
examples of skin disease. The work will be of great value to the practitioner and student.” 
—William Anderson, M. D. (St. Thomas Hospital). 






CATALOGUE OF MEDICAL WORKS. 


It 


ESSENTIALS OF ANATOMY AND MANUAL OF PRACTI¬ 
CAL DISSECTION, containing “ Hints on Dissection.” By Charles 
B. Nancrede, M. D., Professor of Surgery and Clinical Surgery in the 
University of Michigan, Ann Arbor; Corresponding Member of the Royal 
Academy of Medicine, Rome, Italy; late Surgeon Jefferson Medical Col¬ 
lege, etc. Fourth and revised edition. Post 8vo, over 500 pages, with 
handsome full-page lithographic plates in colors, and over 200 illustrations. 
Price : Extra Cloth or Oilcloth for the dissection-room, $2.00 net. 

Neither pains nor expense has been spared to make this work the most ex¬ 
haustive yet concise Student’s Manual of Anatomy and Dissection ever pub¬ 
lished, either in America or in Europe. 

The colored plates are designed to aid the student in dissecting the muscles, 
arteries, veins, and nerves. The wood-cuts have all been specially drawn and 
engraved, and an Appendix added containing 60 illustrations representing the 
structure of the entire human skeleton, the whole being based on the eleventh 
edition of Gray’s Anatomy . 


“ The plates are of more than ordinary excellence, and are of especial value to students in 
their work in the dissecting-room.”— Journal of American Medical Association. 

“ Should be in the hands of every medical student.”— Cleveland Medical Gazette. 

“ A concise and judicious work.”— Buffalo Medical and Surgical Journal. 


A MANUAL OF PRACTICE OF MEDICINE. By A. A. Stevens, 
A. M., M. D., Instructor of Physical Diagnosis in the University of Penn¬ 
sylvania, and Demonstrator of Pathology in the Woman’s Medical College 
of Philadelphia. Specially intended for students preparing for graduation 
and hospital examinations, and includes the following sections: General 
Diseases, Diseases of the Digestive Organs, Diseases of the Respiratory 
System, Diseases of the Circulatory System, Diseases of the Nervous Sys¬ 
tem, Diseases of the Blood, Diseases of the Kidneys, and Diseases of the 
Skin. Each section is prefaced by a chapter on General Symptomatology. 
Third edition. Post 8vo, 502 pages. Numerous illustrations and selected 
formulae. Price, $2.50. 

Contributions to the science of medicine have poured in so rapidly during the 
last quarter of a century that it is well-nigh impossible for the student, with the 
limited time at his disposal, to master elaborate treatises or to cull from them 
that knowledge which is absolutely essential. From an extended experience in 
teaching, the author has been enabled, by classification, to group allied symp¬ 
toms, and by the judicious elimination of theories and redundant explanations 
to bring within a comparatively small compass a complete outline of the prac¬ 
tice of medicine. 



12 


W. B. SAUNDERS' 


MANUAL OF MATERIA MEDICA AND THERAPEUTICS. 

By A. A. Stevens, A. M., M. D., Instructor of Physical Diagnosis in the 
University of Pennsylvania, and Demonstrator of Pathology in the Woman’s 
Medical College of Philadelphia. 435 pages. Price, Cloth, #2.25. 

This wholly new volume, which is based on the 1S90 edition of the Phai ?7id- 
copoeia, comprehends the following sections: Physiological Action of Drugs, 
Drugs; Remedial Measures other than Drugs; Applied Therapeutics; Incom¬ 
patibility in Prescriptions; Table of Doses; Index of Drugs; and Index of 
Diseases; the treatment being elucidated by more than two hundred formula;. 

“ The author is to be congratulated upon having presented the medical student with as 
accurate a manual of therapeutics as it is possible to prepare.”— Therapeutic Gazette. 

“ Far superior to most of its class ; in fact, it is very good. Moreover, the book is reliable 
and accurate.”— New York Medical Journal. 

“ The author has faithfully presented modern therapeutics in a comprehensive work, . . . 
and it will be found a reliable guide.”— University Medical Magazine. 


NOTES ON THE NEWER REMEDIES: their Therapeutic Ap¬ 
plications and Modes of Administration. By David Cerna, M. D., 
Ph. D., Demonstrator of and Lecturer on Experimental Therapeutics in 
the University of Pennsylvania. Second edition, revised and enlarged. 

Post-octavo, 253 pages. Price, $1.25. 

SECOND EDITION, RE-WRITTEN AND GREATLY ENLARGED. 

The work takes up in alphabetical order all the newer remedies, giving their 
physical properties, solubility, therapeutic applications, administration, and 
chemical formula. 

It thus forms a very valuable addition to the various works on therapeutics 
now in existence. 

Chemists are so multiplying compounds, that, if each compound is to be thor¬ 
oughly studied, investigations must be carried far enough to determine the prac¬ 
tical importance of the new agents. 

“ Especially valuable because of its completeness, its accuracy, its systematic consider¬ 
ation of the properties and therapy of many remedies of which doctors generally know but 
little, expressed in a brief yet terse manner.”— Chicago Clinical Review. 


TEMPERATURE CHART. Prepared by D. T. Laine, M. D. Size 
8x 13^ inches. Price, per pad of 25 charts, 50 cents. 

A conveniently arranged chart for recording Temperature, with columns for 
daily amounts of Urinary and Fecal Excretions, Food, Remarks, etc. On the 
back of each chart is given in full the method of Brand in the treatment of 
Typhoid Fever. 




13 


CATALOGUE OF MEDICAL WORKS. 


SAUNDERS POCKET MEDICAL LEXICON; or, Dictionary of 
Terms and Words used in Medicine and Surgery. By John M. 
Keating, M. D., editor of “Cyclopaedia of Diseases of Children,” etc.; 
author ol the “New Pronouncing Dictionary of Medicine; and Henry 
Hamilton, author of “ A New Translation of Virgil’s Hmeid into Eng¬ 
lish Verse;” co-author of a “ New Pronouncing Dictionary of Medicine.” 
A new and revised edition. 321-no, 282 pages. Prices: Cloth, 75 cents; 
Leather Tucks, $1.00. 

This new and comprehensive work of reference is the outcome of a demand 
for a more modern handbook of its class than those at present on the market, 
which, dating as they do from 1855 t0 1884, are of hut trifling use to the student 
by their not containing the hundreds of new words now used in current litera¬ 
ture, especially those relating to Electricity and Bacteriology. 

“ Remarkably accurate in terminology, accentuation, and definition —Journal of Amer¬ 
ican Medical Association. 

” Brief, yet complete .... it contains the very latest nomenclature in even the newest 
departments of medicine.”— New York Medical Record. 


SAUNDERS’ POCKET MEDICAL FORMULARY. By William 

M. Powell, M. D., Attending Physician to the Mercer House for Invalid 
Women at Atlantic City. Containing 1750 Formulae, selected from several 
hundred of the best-known authorities. Forming a handsome and con¬ 
venient pocket companion of nearly 300 printed pages, with blank leaves 
for Additions; with an Appendix containing Posological Table, Formulae 
and Doses for Hypodermatic Medication, Poisons and their Antidotes, 
Diameters of the Pemale Pelvis and Foetal Head, Obstetrical Table, Diet 
List for Various Diseases, Materials and Drugs used in Antiseptic Surgery, 
Treatment of Asphyxia from Drowning, Surgical Remembrancer, Tables 
of Incompatibles, Eruptive Fevers, Weights and Measures, etc. Third 
edition, revised and greatly enlarged. Handsomely bound in morocco, 
with side index, wallet, and flap. Price, $1.75 net. 

A concise, clear, and correct record of the many hundreds of famous formulae 
which are found scattered through the works of the most eminent physicians 
and surgeons of the world. The work is helpful to the student and practitioner 
alike, as through it they become acquainted with numerous formulae which are 
not found in text-books, but have been collected from among the rising genera¬ 
tion of the profession, college professors , and hospital physicians and surgeons. 

“ This little book, that can be conveniently carried in the pocket, contains an immense 
amount of material. It is very useful, and as the name of the author of each prescription is 
given is unusually reliable.”— New York Medical Record. 

“ Designed to be of immense help to the general practitioner in the exercise of his daily 
calling.”— Boston Medical and Surgical Journal. 






14 


IV. B. SAUNDERS' 


DISEASES OF WOMEN. By Henry J. Garrigues, A. M., M. D., 

Professor of Obstetrics in the New York Post-Graduate Medical School 
and Hospital; Gynecologist to St. Mark’s Hospital and to the German 
Dispensary, etc., New York City. In one very handsome octavo volume 
of about 700 pages, illustrated by numerous wood-cuts and colored plates. 
Prices : Cloth, $4.00 net; Sheep, $5.00 net. 

A PRACTICAL work on gynecology for the use of students and practitioners, 
written in a terse and concise manner. The importance of a thorough know¬ 
ledge of the anatomy of the female pelvic organs has been fully recognized by 
the author, and considerable space has been devoted to the subject. The chap¬ 
ters on Operations and on Treatment are thoroughly modern, and are based 
upon the large hospital and private practice of the author. The text is eluci¬ 
dated by a large number of illustrations and colored plates, many of them being 
original, and forming a complete atlas for studying embryology and the anatomy 
of \XiQ female genitalia, besides exemplifying, whenever needed, morbid condi¬ 
tions, instruments, apparatus, and operations. 

EXCERPT OF CONTEXTS. 

Development of the Female Genitals.—Anatomy of the Female Pelvic Organs.—Phys¬ 
iology.—Puberty.—Menstruation and Ovulation.—Copulation.—Fecundation.—The Climac¬ 
teric.—Etiology in General.—Examinations in General.—Treatment in General—Abnormal 
Menstruation and Metrorrhagia.—Leucorrhea.—Diseases of the Vulva.—Diseases of the 
Perineum.—Diseases of the Vagina.—Diseases of the Uterus.—Diseases of the Fallopian 
Tubes.—Diseases of the Ovaries.—Diseases of the Pelvis.—Sterility. 

The reception accorded to this work has been most flattering. In the short 
period which has elapsed since its issue it has been adopted and recommended 
as a text-book by more than 60 of the Medical Schools and Universities of the 
United States and Canada. 

“ One of the best text-books for students and practitioners which has been published in 
the English language; it is condensed, clear, and comprehensive. The profound learning 
and great clinical experience of the distinguished author find expression in this book in a 
most attractive and instructive form. Young practitioners, to whom experienced consultants 
may not be available, will find in this book invaluable counsel and help.” 

Thad. A. Reamy, M. D., LL.D., 

Professor of Clinical Gynecology, Medical College of Ohio; Gynecologist to the Good 

Samaritan and Cincinnati Hospitals. 


A SYLLABUS OF GYNECOLOGY, arranged in conformity with 
“An American Text-Book of Gynecology.” By J. W. Long, M. D., 
Professor of Diseases of Women and Children, Medical College of Vir¬ 
ginia, etc. Price, Cloth (interleaved), $1.00 net. 

Based upon the teaching and methods laid down in the larger work, this will 
not only be useful as a supplementary volume, but to those who do not already 
possess the text-book it will also have an independent value as an aid to the 
practitioner in gynecological work, and to the student as a guide in the lecture- 
room, as the subject is presented in a manner at once systematic, clear, succinct, 
and practical. / 




CATALOGUE OF MEDICAL WORKS. 


15 


OUTLINES OF OBSTETRICS: A Syllabus of Lectures Deliv¬ 
ered at Long Island College Hospital. By Charles Jewett, A. M., 
M. D., Professor of Obstetrics and Pediatrics in the College, and Obstetri¬ 
cian to the Hospital. Edited by Harold F. Jewett, M. D. Post 8vo, 
264 pages. Price, $2.00. 

This book treats only of the general facts and principles of obstetrics : these 
are stated in concise terms and in a systematic and natural order of sequence, 
theoretical discussion being as far as possible avoided; the subject is thus 
presented in a form most easily grasped and remembered by the student. 
Special attention has been devoted to practical questions of diagnosis and 
treatment, and in general particular prominence is given to facts which the stu¬ 
dent most needs to know. The condensed form of statement and the orderly 
arrangement of topics adapt it to the wants of the busy practitioner as a means 
of refreshing his knowledge of the subject and as a handy manual for daily 
reference. 

Rarely has it been our fortune to read a work of this nature where, from the beginning to 
the end, definitions are so exact and rules for guidance so safe .”—American Journal of 
Obstetrics , New York. 


SYLLABUS OF OBSTETRICAL LECTURES in the Medical 
Department, University of Pennsylvania. By Richard C. Norris, 
A. M., M. D., Demonstrator of Obstetrics in the University of Pennsyl¬ 
vania. Third edition, thoroughly revised and enlarged. Crown 8vo. 
Price, Cloth, interleaved for notes, $ 2.00 net. 


“ This work is so far superior to others on the same subject that we take pleasure in call¬ 
ing attention briefly to its excellent features. It covers the subject thoroughly, and will 
prove invaluable both to the student and the practitioner. The author has introduced a 
number of valuable hints which would only occur to one who was himself an experienced 
teacher of obstetrics. The subject-matter is clear, forcible, and modern. We are especially 
pleased with the portion devoted to the practical duties of the accoucheur, care of the child, 
etc. The paragraphs on antiseptics are admirable; there is no doubtful tone in the direc¬ 
tions given. No details are regarded as unimportant; no minor matters omitted. We ven¬ 
ture to say that even the old practitioner will find useful hints in this direction which he can¬ 
not afford to despise .”—New York Medical Record. 


A SYLLABUS OF LECTURES ON THE PRACTICE OF SUR¬ 
GERY, arranged in conformity with “ An American Text-Book 
of Surgery.” By N. Senn, M. D., Ph. D., Professor of Surgery in Rush 
Medical College, Chicago, and in the Chicago Polyclinic. Price, $2.00. 

This, the latest work of its eminent author, himself one of the contributors 
to “ An American Text-Book of Surgery,” will prove of exceptional value to 
the advanced student who has adopted that work as his text-book. It is not 
only the syllabus of an unrivalled course of surgical practice, but it is also an 
epitome of or supplement to the larger work. 

“ The author has evidently spared no pains in making his Syllabus thoroughly comprehen¬ 
sive, and has added new matter and alluded to the most recent authors and operations. Full 
references are also given to all requisite details of surgical anatomy and pathology.”— British 
Medical Journal, London. 





i6 


W. B. SAUNDERS' 


AN OPERATION BLANK, with Lists of Instruments, etc. re¬ 
quired in Various Operations. Prepared by W. W. Keen, M. D., 
LL.D., Professor of Principles of Surgery in the Jefferson Medical Col¬ 
lege, Philadelphia. Price per Pad, containing Blanks for fifty operations, 
50 cents net. 

SECOND EDITION, REVISED FORM. 

A convenient blank, suitable for all operations, giving complete instructions 
regarding necessary preparation of patient, etc., with a full list of dressings and 
medicines to be employed. 

On the back of each blank is a list of instruments used—viz. general instru¬ 
ments, etc., required for all operations; and special instruments for surgery of 
the brain and spine, mouth and throat, abdomen, rectum, male and female 
genito-urinary organs, the bones, etc. 

The whole forming a neat pad, arranged for hanging on the wall of a sur¬ 
geon’s office or in the hospital operating-room. 

“Will serve a useful purpose for the surgeon in reminding him of the details of prepa¬ 
ration for the patient and the room as well as for the instruments, dressings, and antiseptics 
needed ”— New York Medical Record 

“ Covers about all that can be needed in any operation."— American Lancet. 

“ The plan is a capital one."— Boston Medical and Surgical Journal. 

LABORATORY EXERCISES IN BOTANY. By Edson S. Bastin, 

M. A., Professor of Materia Medica and Botany in the Philadelphia Col¬ 
lege of Pharmacy. Octavo volume of 536 pages, 87 full-page plates. Price, 
Cloth, $2.50. 

This work is intended for the beginner and the advanced student, and it fully 
covers the structure of flowering plants, roots, ordinary stems, rhizomes, tubers, 
bulbs, leaves, flowers, fruits, and seeds. Particular attention is given to the gross 
and microscopical structure of plants, and to those used in medicine. Illustra¬ 
tions have freely been used to elucidate the text, and a complete index to facil¬ 
itate reference has been added. 

TEXT-BOOK UPON THE PATHOGENIC BACTERIA. Specially 
written for students of medicine. By Joseph McFarland, M. D., Demon¬ 
strator of Pathological Histology, and Lecturer on Bacteriology, in the 
Medical Department of the University of Pennsylvania. Price, Cloth, 
$2.50 net. 

A concise account of the technical procedures necessary in the study of Bac¬ 
teriology. Finely illustrated. 

A GUIDE TO THE BACTERIOLOGICAL LABORATORY. By 

Langdon Frothingham, M. D. Illustrated. Price, 75 cents. 

The technical methods involved in bacteria-culture, methods of staining, and 
microscopical study are fully described and arranged as simply and concisely as 
possible. The book is especially intended for use in laboratory work. 



CATALOGUE OF MEDICAL WORKS. 


17 


HOW TO EXAMINE FOR LIFE INSURANCE. By John M. 
Keating, M. D., Fellow of the College of Physicians and Surgeons of 
Philadelphia; Vice-President of the American Paediatric Society; Ex- 
President of the Association of Life Insurance Medical Directors. Royal 
8vo, 211 pages, with two large half-tone illustrations, and a plate prepared 
by Dr. McClellan from special dissections; also, numerous cuts to elucidate 
the text. Second edition. Price, Cloth, $2.00 net. 

Part I., carefully prepared from the best works on Physical Diagnosis, gives a 
succinct account of the methods used in making examinations, and a 
description of the normal condition and of the earliest evidences of disease. 

Part II. contains the Instructions of twenty-four Life-Insurance Companies to 
their medical examiners. 

“ This is by far the most useful book which has yet appeared on insurance examination, a 
subject of growing interest and importance. Not the least valuable portion of the volume is 
Part II., which consists of instructions issued to their examining physicians by twenty-four 
representative companies of this country. As the proofs of these instructions were corrected 
by the directors of the companies, they form the latest instructions obtainable. If for these 
alone, the book should be at the right hand of every physician interested in this special branch 
of medical science .”—The Medical News , Philadelphia. 


NURSING: ITS PRINCIPLES AND PRACTICE. By Isabel 
Adams Hampton, Graduate of the New York Training School for 
Nurses attached to Bellevue Hospital; Superintendent of Nurses and 
Principal of the Training School for Nurses, Johns Hopkins Hospital, 
Baltimore, Md.; late Superintendent of Nurses, Illinois Training School 
for Nurses, Chicago, Ill. In one very handsome i2mo volume of 484 
pages, profusely illustrated. Price, Cloth, $ 2.00 net. 

This original work on the important subject of nursing is at once comprehensive 
and systematic. It is written in a clear, accurate, and readable style, suitable 
alike to the student and the lay reader. Such a work has long been a desidera¬ 
tum with those entrusted with the management of hospitals and the instruction of 
nurses in training-schools. It is also of especial value to the graduated nurse 
who desires to acquire a piactical working knowledge of the care of the sick 
and the hygiene of the sick-room. 

PRACTICAL POINTS IN NURSING. For Nurses in Private 
Practice. By Emily A. M. Stoney, Graduate of the Training-school 
for Nurses, Lawrence, Massachusetts; Superintendent of Training-school 
for Nurses, Carney Hospital, South Boston. i2mo., 400 pages. Price, 
Cloth, #1.75 net. 

A vade mecum for the private nurse, and an efficient teaching-book for train¬ 
ing-schools. A valuable feature is the instructions for quickly improvising 
needed sick-room appliances. 





18 


W. B. SAUNDERS' 


THE CARE OF THE BABY. By J. P. Crozer Griffith, M. D., 
Clinical Professor of Diseases of Children, and Instructor in Clinical 
Medicine, Medical Department University of Pennsylvania; Physician to 
St. Agnes’, Howard, St. Clement’s, and the Children’s Hospitals, Phila¬ 
delphia, etc. 392 pages, with 67 illustrations in the text, and 5 plates. 
i2mo. Price, $1.50. 

A reliable guide not only for mothers, but also for medical students and 
practitioners whose opportunities for observing children have been limited. 

THE NURSE’S DICTIONARY of Medical Terms and Nursing 
Treatment, containing Definitions of the Principal Medical and Nursing 
Terms, Abbreviations, and Physiological Names, and Descriptions of the 
Instruments, Drugs, Diseases, Accidents, Treatments, Operations, Foods, 
Appliances, etc. encountered in the ward or in the sick-room. Compiled 
for the use of nurses. By Honnor Morten, author of “ How to Become 
a Nurse,” “Sketches of Hospital Life,” etc. i6mo, 140 pages. Price, 
Cloth, $1.00. 

This little volume is intended for use merely as a small reference-book which 
can be consulted at the bedside or in the ward. It gives sufficient explanation 
to the nurse to enable her to comprehend a case until she has leisure to look up 
larger and fuller works on the subject. 

DIET LISTS AND SICK-ROOM DIETARY. By Jerome B. Thomas, 
M. D., Visiting Physician to the Home for Friendless Women and Children 
and to the Newsboys’ Home; Assistant Visiting Physician to the Kings 
County Hospital; Assistant Bacteriologist, Brooklyn Health Department. 
Price, Cloth, (Send for specimen List.) 

One hundred and sixty detachable (perforated) diet lists for Albuminuria, 
Anaemia and Debility, Constipation, Diabetes, Diarrhoea, Dyspepsia, Fevers, 
Gout or Uric-Acid Diathesis, Obesity, and Tuberculosis. Also forty detachable 
sheets of Sick-Room Dietary, containing full instructions for preparation of 
easily-digested foods necessary for invalids. Each list is numbered only , the 
disease for which it is to be used in no case being mentioned, an index key 
being reserved for the physician’s private use. 

DIETS FOR INFANTS AND CHILDREN IN HEALTH AND 
IN DISEASE. By Louis Starr, M. D., Editor of “An American 
Text-Book of the Diseases of Children.” 230 blanks (pocket-book size), 
perforated and neatly bound in flexible morocco. Price, $1.25 net. 

The first series of blanks are prepared for the first seven months of infant 
life; each blank indicates the ingredients, but not the quantities, of the food, 
the latter directions being left for the physician. After the seventh month, 
modifications being less necessary, the diet lists are printed in full. Formula 
for the preparation of diluents and foods are appended. 




Practical, Exhaustive, Authoritative, 


SAUNDERS’ 

NEW AID SERIES OF MANUALS 

FOR 

Students and Practitioners. 


Mr. Saunders is pleased to announce as now ready bis NEW AID 
SERIES OF MANUALS for Students and Practitioners. As pub¬ 
lisher of the Standard Series of Question Compends, and through intimate 
relations with leading members of the medical profession, Mr. Saunders has 
been enabled to study progressively the essential desiderata in practical “ self- 
helps ” for students and physicians. 

This study has manifested that, while the published “ Question Compends ” 
earn the highest appreciation of students, whom they serve in reviewing their 
studies preparatory to examination, there is special need of thoroughly reliable 
handbooks on the leading branches of Medicine and Surgery, each subject 
being compactly and authoritatively written, and exhaustive in detail, without 
the introduction of cases and foreign subject-matter which so largely expand 
ordinary text-books. 

The Saunders Aid Series will not merely be condensations from 
present literature, but will be ably written by well-known authors 
and practitioners, most of them being teachers in representative 
American Colleges. This nezv series , therefore, will form an admirable 
collection of advanced lectures, which will be invaluable aids to students in 
reading and in comprehending the contents of “recommended” works. 

Each Manual will further be distinguished by the beauty of the new type; 
by the quality of the paper and printing; by the copious use of illustrations; 
by the attractive binding in cloth; and by their extremely low prices. 

19 




SAUNDERS’ NEW AID SERIES OF MANUALS. 


VOLUMES PUBLISHED. 


PHYSIOLOGY. By Joseph Howard Raymond, A. M., M. D., Professor 
of Physiology and Hygiene and Lecturer on Gynecology in the Long 
Island College Hospital, etc. Price, $1.25 net. 

SURGERY, General and Operative. By John Chalmers DaCosta, 
M. D„ Demonstrator of Surgery, Jefferson Medical College, Philadelphia, 
etc. Double number. Price, $2.50 net. 

DOSE-BOOK AND MANUAL OF PRESCRIPTION-WRITING. 

By E. Q. Thornton, M. D., Demonstrator of Therapeutics, Jefferson 
Medical College, Philadelphia. Price, $1.25 net. 

MEDICAL JURISPRUDENCE. By Henry C. Chapman, M. D., Pro¬ 
fessor of Institutes of Medicine and Medical Jurisprudence in the Jeffer¬ 
son Medical College of Philadelphia, etc. Price, $1.50 net. 

SURGICAL ASEPSIS. By Carl Beck, M.D., Surgeon to St. Mark’s 
Hospital and to the German Poliklinik; Instructor in Surgery, New York 
Post-Graduate Medical School, etc. Price, $1.25 net. 

MANUAL OF ANATOMY. By Irving S. Haynes, M. D., Adjunct 
Professor of Anatomy and Demonstrator of Anatomy, Medical Department 
of the New York University, etc. (Double number.) Price, $2.50 net. 

SYPHILIS AND THE VENEREAL DISEASES. By James 
Nevins Hyde, M. D., Professor of Skin and Venereal Diseases, and 
Frank H. Montgomery, M. D., Lecturer on Dermatology and Genito¬ 
urinary Diseases, in Rush Medical College, Chicago. (Double number.) 
Price, $2.50 net. 

PRACTICE OF MEDICINE. By George Roe Lockwood, M. D., 
Professor of Practice in the Woman’s Medical College of the New 
York Infirmary, etc. (Double number.) Price, $2.50 net. 

OBSTETRICS. By W. A. Newman Dorland, M.D., Asst. Demonstrator 
of Obstetrics, University of Pennsylvania; Chief of Gynecological Dispen¬ 
sary, Pennsylvania Hospital. (Double number.) Price, $2.50 net. 

VOLUMES IN PREPARATION. 

MATERIA MEDICA AND THERAPEUTICS. By Henry A. 
Griffin, A. B., M. D., Assistant Physician to the Roosevelt Hospital, 
Out-Patient Department, New York City. 

NERVOUS DISEASES. By Charlf:s W. Burr, M. D., Clinical Pro¬ 
fessor of Nervous Diseases, Medico-Chirurgical College, Philadelphia, etc. 

NOSE AND THROAT. By D. Braden Kyle, M. D., Chief Laryngolo¬ 
gist to St. Agnes’ Hospital, Philadelphia; Instructor in Clinical Microscopy 
and Assistant Demonstrator of Pathology in Jefferson Medical College. 

PATHOLOGY. By Alfred Stengel, M. D., Instructor in Clinical Medi¬ 
cine, Medical Department, University of Pennsylvania. 

*** There will be published in the same series, at short intervals, carefully-pre¬ 
pared works on the subjects of Anatomy, Gynecology, Hygiene, etc., by prom¬ 
inent specialists. 




SAUNDERS’ QUESTION COMPENDS 

Arranged in Question and Answer Form. 


THE LATEST, CHEAPEST, and BEST ILLUSTRATED 
SERIES OP COMPENDS EVER ISSUED. 


Now the Standard Authorities in Medical Literature 

WITH 

Students and Practitioners in every City of the United 

States and Canada. 


THE REASON WHY. 

They are the advance guard of “ Student’s Helps ”—that do help; they are 
the leaders in their special line, well and authoritatively written by able men , 
who , as teachers in the large colleges, know exactly what is wanted by a student 
preparing for his examinations. The judgment exercised in the selection of 
authors is fully demonstrated by their professional elevation. Chosen from the 
ranks of Demonstrators, Quiz-masters, and Assistants, most of them have be¬ 
come Professors and Lecturers in their respective colleges. 

Each book is of convenient size (5x7 inches), containing on an average 250 
pages, profusely illustrated, and elegantly printed in clear, readable type, on 
fine paper. 

The entire series, numbering twenty-four subjects, has been kept thoroughly 
revised and enlarged when necessary, many of them being in their fourth and 
fifth editions. 

TO SUM UP. 

Although there are numerous other Quizzes, Manuals, Aids, etc. in the mar¬ 
ket, none of them approach the “ Blue Series of Question Compends;” and 
the claim is made for the following points of excellence: 

1. Professional distinction and reputation of authors. 

2. Conciseness, clearness, and soundness of treatment. 

3. Size of type and quality of paper and binding. 

Any of these Compends will be mailed on receipt of price (see over 
for List). 


21 





SAUNDERS’ QUESTION-COMPEND SERIES. 


Price, Cloth, $1.00 per copy, except when otherwise noted. 


1. ESSENTIALS OF PHYSIOLOGY. 3d edition. Illustrated. Re- 

vised and enlarged by H. A. Hare, M. D (Price, $1.00 net.) 

2. ESSENTIALS OF SURGERY. 5th edition, with an Appendix on 

Antiseptic Surgery. 90 illustrations. By Edward Martin, M. D. 

3. ESSENTIALS OF ANATOMY. 5th edition, with an Appendix. 180 

illustrations. By Charles B. Nancrede, M. D. 

4. ESSENTIALS OF MEDICAL CHEMISTRY, ORGANIC AND 

INORGANIC. 4th edition, revised, with an Appendix. By Law¬ 
rence Wolff, M. D. 

5. ESSENTIALS OF OBSTETRICS. 3d edition, revised and en¬ 

larged. 75 illustrations. By W. Easterly Ashton, M. D. 

6. ESSENTIALS OF PATHOLOGY AND MORBID ANATOMY. 

6th thousand. 46 illustrations. By C. E. Armand Semple, M. D. 

7. ESSENTIALS OF MATERIA MEDICA, THERAPEUTICS, 

AND PRESCRIPTION-WRITING. 4th edition. By Henry 
Morris, M. D. 

8. 9. ESSENTIALS OF PRACTICE OF MEDICINE. By Henry 

Morris, M. D. An Appendix on Urine Examination. Illustrated. 
By Lawrence Wolff, M. D. 3d edition, enlarged by some 300 Es¬ 
sential Formulae, selected from eminent authorities, by Wm. M. Powell, 
M. D. (Double number, price $2.00.) 

10. ESSENTIALS OF GYNAECOLOGY. 3d edition, revised. With 

62 illustrations. By Edwin B. Cragin, M. D. 

11. ESSENTIALS OF DISEASES OF THE SKIN. 3d edition, re¬ 

vised and enlarged. 71 letter-press cuts and 15 half-tone illustrations. 
By Henry W. Stelwagon, M. D. (Price, $1.00 net.) 

12. ESSENTIALS OF MINOR SURGERY, BANDAGING, AND 

VENEREAL DISEASES. 2d edition, revised and enlarged. 78 
illustrations. By Edward Martin, M. D. 

13. ESSENTIALS OF LEGAL MEDICINE, TOXICOLOGY, AND 

HYGIENE. 130 illustrations. By C. E. Armand Semple, M. D. 

14. ESSENTIALS OF DISEASES OF THE EYE, NOSE, AND 

THROAT. 124 illustrations. 2d edition, revised. By Edward 
Jackson, M. D., and E. Baldwin Gleason, M. D. 

15. ESSENTIALS OF DISEASES OF CHILDREN. 4th thousand. 

By William H. Powell, M. D. 

16. ESSENTIALS OF EXAMINATION OF URINE. Colored 

“ Vogel Scale,” and numerous illustrations. By Lawrence Wolff, 
M. D. (Price, 75 cents.) 

17. ESSENTIALS OF DIAGNOSIS. By S. Solis-Cohen, M. D., and 

A. A. Eshner, M. D. 55 illustrations, some in colors. (Price, $1.50 net.) 

18. ESSENTIALS OF PRACTICE OF PHARMACY. By L. E. 

Sayre. 2d edition, revised. 

20. ESSENTIALS OF BACTERIOLOGY. 2d edition. 81 illustra¬ 

tions. By M. V. Ball, M. D. 

21. ESSENTIALS OF NERVOUS DISEASES AND INSANITY. 

48 illustrations. 2d edition, revised. By John C. Shaw, M. D. 

22. ESSENTIALS OF MEDICAL PHYSICS. 155 illustrations. 2d 

edition, revised. By Fred J. Brockway, M. D. (Price, $1.00 net.) 

23. ESSENTIALS OF MEDICAL ELECTRICITY. 65 illustrations. 

By David D. Stewart, M. D., and Edward S. Lawrance, M. D. 

24. ESSENTIALS OF DISEASES OF THE EAR. By E. B. Glea¬ 

son, M. D. 89 illustrations. 




RECENT PUBLICATIONS. 


AN AMERICAN TEXT-BOOK OF PHYSIOLOGY. Edited by 
William H. Howell, Ph. D., M. D,, Professor of Physiology in the 
Johns Hopkins University, Md. One handsome octavo volume of 1052 
pages, fully illustrated. Prices : Cloth, $6.00 net; Sheep or Half-Morocco, 
$7.00 net. 

AN AMERICAN TEXT-BOOK OF APPLIED THERAPEUTICS. 
For the Use of Practitioners and Students. Edited by James C. 
Wilson, M. D., Professor of the Practice of Medicine and of Clinical 
Medicine in the Jefferson Medical College. One handsome octave volume 
of 1326 pages. Illustrated. Prices: Cloth, $7.00 net; Sheep or Half- 
Morocco, $8.00 net. 

A TEXT-BOOK OF MATERIA MEDICA, THERAPEUTICS, 
AND PHARMACOLOGY. By George F. Butler, Ph. G., M. D., 
Professor of Materia Medica and of Clinical Medicine in the College of 
Physicians and Surgeons, Chicago, etc. 8vo, 858 pages. Illustrated. 
Prices : Cloth, $4.00 net; Sheep or Half-Morocco, $5.00 net. 

A TEXT-BOOK OF HISTOLOGY, DESCRIPTIVE AND PRAC¬ 
TICAL. For the Use of Students. By Arthur Clarkson, M. B., 
C. M., Edin. Large 8vo, 554 pages, with 22 engravings in the text, and 
174 beautifully colored original illustrations. Price, strongly bound in 
Cloth, $ 6.00 net. 

ESSENTIALS OF PHYSICAL DIAGNOSIS OF THE THORAX. 

By Arthur M. Corwin, A. M., M. D., Demonstrator of Physical Diag¬ 
nosis in the Rush Medical College, Chicago; Attending Physician to the 
Central Free Dispensary, Department of Rhinology, Laryngology, and 
Diseases of the Chest. 200 pages. Illustrated. Cloth, flexible covers. 
Price, $1.25 net. 

ARCHIVES OF CLINICAL SKIAGRAPHY. By Sydney Rowland, 
B. A., Camb. A series of collotype illustrations, with descriptive text, 
illustrating the applications of the new photography to Medicine and Sur¬ 
gery. Price, per Part, $1.00. Parts I. and IT. now ready. 

OBSTETRIC ACCIDENTS, EMERGENCIES, AND OPERA¬ 
TIONS. By L. Ch. Boisliniere, M. D., late Emeritus Professor of Ob¬ 
stetrics in the St. Louis Medical College. 3S 1 pages, handsomely illus¬ 
trated. Price, $2.00 net. 

WATER AND WATER SUPPLIES. By John C. Thresh, D. Sc., 
M. B., D. P. II. i2mo, 438 pages, illustrated. Handsomely bound in 
Cloth, with gold side and back stamps. Price, $2.25 net. 


The knowledge gained is equal to a post-graduate course, 


NOW READY, VOLUME FOR 1896 . 


SA_XJiTIDE^S 7 

AMERICAN YEAR BOOK OF MEDICINE and SURGERY. 

Edited by GEORGE M. GOULD, A. 1VL, M. D. 
Assisted by Eminent American Specialists and Teachers. 

Notwithstanding the rapid multiplication of medical and surgical works, 
still these publications fail to meet fully the requirements of the general physician. 
inasmuch as he feels the need of something more than mere text-books of well- 
known principles of medical science. Mr. Saunders has long been impressed 
with this fact, which is confirmed by the unanimity of expression from the pro¬ 
fession at large, as indicated by advices from his large corps of canvassers. 

This deficiency would best be met by current journalistic literature, but most 
practitioners have scant access to this almost unlimited source of information, 
and the busy practiser has but little time to search out in periodicals the many 
interesting cases whose study would doubtless be of inestimable value in his 
practice. Therefore, a work which places before the physician in convenient 
form an epitomization of this literature by persons competent to pronounce upon 
The Value of a Discovery or of a Method of Treatment 

cannot but command his highest appreciation. It is this critical and judicial 
function that will be assumed by the Editorial staff of the “ American Year- 
Book of Medicine and Surgery.” 

It is the special purpose of the Editor, whose experience peculiarly qualifies 
him for the preparation of this work, not only to review the contributions to 
American journals, but also the methods and discoveries reported in the leading 
medical journals of Europe, thus enlarging the survey and making the work 
characteristically international. These reviews will not simply be a series of 
undigested abstracts indiscriminately run together, nor will they be retrospective 
of “ news ” one or two years old , but the treatment presented will be synthetic 
and dogmatic , and will include onlj' what is new. Moreover, through expert 
condensation by experienced writers these discussions will be 

Comprised in a Single Volume of about 1200 Pages. 

The work will be replete with original and selected illustrations skilfully 
reproduced, for the most part in Mr. Saunders’ own studios established for the 
purpose, thus ensuring accuracy in delineation, affording efficient aids to a right 
comprehension of the text, and adding to the attractiveness of the volume. 
Prices : Cloth, $6.50 net; Half Morocco, $7.50 net. 

W. B. SAUNDERS, Publisher, 

925 Walnut Street, Philadelphia. 


Uniform with the “American Text-Book” Series. 





JUST ISSUED. 

PENROSE’S DISEASES OF WOMEN. 

A Text=Book of Diseases of Women. By Charles B. Penrose, M. D., Ph. D., 
Professor of Gynecology, University of Pennsylvania; Surgeon to the Gynecean 
Hospital, Philadelphia. Octavo volume of 529 pages, handsomely illustrated. 
Price, $3.50 net. 

MALLORY AND WRIGHT’S PATHOLOGICAL TECHNIQUE. 

Pathological Technique. By Frank B. Mallory, A. M., M.D., Asst. Professor 
of Pathology, Harvard Medical School; and James H. Wright, A. M., M. D., In¬ 
structor in Pathology, Harvard Medical School. Octavo volume of 390 pages, 
handsomely illustrated. Price, 

SENN’S GENITOURINARY TUBERCULOSIS. 

Tuberculosis of the Genito=Urinary Organs, Male and Female. By Nicholas 
Senn, M. D., Ph. D., LL.D., Professor of the Practice of Surgery and of Clinical 
Surgery, Rush Medical College, Chicago. Handsome octavo volume of 320 
pages. Illustrated. Price, 

SUTTON AND GILES’ DISEASES OF WOMEN. 

Diseases of Women. By J. Bland Sutton, F. R. C. S., Asst. Surgeon to Middle¬ 
sex Hospital, and Surgeon to Chelsea Hospital, London ; and Arthur E. Giles, 
M. D., B. Sc. Lond., F. R. C. S. Edin., Asst. Surgeon to Chelsea Hospital, London. 
436 pages, handsomely illustrated. Price, $2.50 net. 


IN PREPARATION. 

ANDERS’ PRACTICE OF MEDICINE. 

A Text=Book of the Practice of Medicine. By James M. Anders, M. D., Ph. D., 

LL.D., Professor of the Practice of Medicine and of Clinical Medicine, Medico- 
Chirurgical College, Philadelphia. In press. 

MACDONALD’S SURGICAL DIAGNOSIS AND TREATMENT. 

Surgical Diagnosis and Treatment. By J. W. Macdonald, M. D., Professor of 
the Practice of Surgery and of Clinical'Surgery, Minneapolis College of Physi¬ 
cians and Surgeons. In press. 

AN AMERICAN TEXT BOOK OF GENITOURINARY AND SKIN 
DISEASES. 

Edited by L. Bolton Bangs, M. D., Late Professor of Genito-Urinary and Venereal 
Diseases, New York Post-Graduate Medical School and Hospital, and William 
A. Hardaway, M. D., Professor of Diseases of the Skin, Missouri Medical College. 

AN AMERICAN TEXT=BOOK OF DISEASES OF THE EYE, 
EAR, NOSE, AND THROAT. 

Edited by G. E. de Schweinitz, M. D., Professor of Ophthalmology in the Jeffer¬ 
son Medical College, and B. Alexander Randall, M. D., Professor of Diseases 
of the Ear in the University of Pennsylvania. 

HIRST’S OBSTETRICS. 

A Text=Book of Obstetrics. By Barton Cooke Hirst, M. D., Professor of Obstet¬ 
rics, University of Pennsylvania. 

MOORE’S ORTHOPEDIC SURGERY. 

A Manual of Orthopedic Surgery. By James E. Moore, M. D., Professor of 
Orthopedics and Adjunct Professor of Clinical Surgery, University of Minnesota, 
College of Medicine and Surgery. 

HEISLER’S EMBRYOLOGY. 

A Text=Book of Embryology. By John C. Heisler, M. D., Prosector to the Pro¬ 
fessor of Anatomy, Medical Department, University of Pennsylvania. 



The Knowledge gained is equal to a post-graduate course, 


Kail HEADY, VOLUMES FOR 1896 AND 1897. 


AMERICAN YEAR-BOOK OF MEDICINE and SURGERY. 

Edited by GEORGE M. GOULD, A. IVL, M. D. 

Assisted by Eminent American Specialists and Teachers. 

Notwithstanding the rapid multiplication of medical and surgical works, 
still these publications fail to meet fully the requirements of the general physician, 
inasmuch as he feels the need of something more than mere text-books of well- 
known principles of medical science. Mr. Saunders has long been impressed 
with this fact, which is confirmed by the unanimity of expression from the pro¬ 
fession at large, as indicated by advices from his large corps of canvassers. 

This deficiency would best be met by current journalistic literature, but most 
practitioners have scant access to this almost unlimited source of information, 
and the busy practiser has but little time to search out in periodicals the many 
interesting cases whose study would doubtless be of inestimable value in his 
practice. Therefore, a work which places before the physician in convenient 
form an epitomization of this literature by persons cofnpetent to pronounce upon 
The Value of a Discovery or of a Method of Treatment 

cannot but command his highest appreciation. It is this critical and judicial 
function that will be assumed by the Editorial staff of the “ American Year- 
Book of Medicine and Surgery.” 

It is the special purpose of the Editor, whose experience peculiarly qualifies 
him for the preparation of this work, not only to review the contributions to 
American journals, but also the methods and discoveries reported in the leading 
medical journals of Europe, thus enlarging the survey and making the work 
characteristically international. These reviews will not simply be a series of 
undigested abstracts indiscriminately run together, nor will they be retrospective 
of “ news ” one or tiuo years old , but the treatment presented will be synthetic 
and dogmatic , and will include only what is new. Moreover, through expert 
condensation by experienced writers these discussions will be 

Comprised in a Single Volume of about 1200 Pages. 

The work will be replete with original and selected illustrations skilfully 
reproduced, for the most part in Mr. Saunders’ own studios established for the 
purpose, thus ensuring accuracy in delineation, affording efficient aids to a right 
comprehension of the text, and adding to the attractiveness of the volume. 
Prices: Cloth, $6.50 net; Half Morocco, $7.50 net. 

W. B. SAUNDERS, Publisher, 

925 Walnut Street, Philadelphia. 


Uniform with the “American Text-liook" Series . 





























































































































































































